Provider Demographics
NPI:1578670428
Name:CONTY-CUEVAS, EVA MADELYN
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MADELYN
Last Name:CONTY-CUEVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 N ELSTON AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5811
Mailing Address - Country:US
Mailing Address - Phone:773-751-7200
Mailing Address - Fax:773-583-4295
Practice Address - Street 1:3319 N ELSTON AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5811
Practice Address - Country:US
Practice Address - Phone:773-751-7200
Practice Address - Fax:773-583-4295
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005814OtherLICENSE