Provider Demographics
NPI:1639251317
Name:SEQUEIRA, EMELITA D (APN)
Entity Type:Individual
Prefix:
First Name:EMELITA
Middle Name:D
Last Name:SEQUEIRA
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 1:977 N OAKLAWN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1045
Mailing Address - Country:US
Mailing Address - Phone:630-832-1775
Mailing Address - Fax:
Practice Address - Street 1:977 N OAKLAWN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1045
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ23776Medicare UPIN