Provider Demographics
NPI:1649752023
Name:QUEZADA, NANCY (APN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:QUEZADA
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 1:2627 WEST CERMARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2325
Mailing Address - Country:US
Mailing Address - Phone:312-698-9040
Mailing Address - Fax:855-618-2276
Practice Address - Street 1:2627 WEST CERMARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2325
Practice Address - Country:US
Practice Address - Phone:312-698-9040
Practice Address - Fax:855-618-2276
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017979363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care