Provider Demographics
NPI:1598943524
Name:SPYRATOS, EVAGELIA (APN)
Entity Type:Individual
Prefix:
First Name:EVAGELIA
Middle Name:
Last Name:SPYRATOS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 SUFFIELD CT
Mailing Address - Street 2:UNIT B
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1675
Mailing Address - Country:US
Mailing Address - Phone:847-568-0673
Mailing Address - Fax:
Practice Address - Street 1:5016 SUFFIELD CT
Practice Address - Street 2:UNIT B
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1675
Practice Address - Country:US
Practice Address - Phone:847-568-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006635363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00716Medicare PIN
ILR00717Medicare PIN