Provider Demographics
NPI:1659008928
Name:BALTAZAR, PATRICIA M (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25138 ROCKWELL LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2236
Mailing Address - Country:US
Mailing Address - Phone:708-903-0998
Mailing Address - Fax:
Practice Address - Street 1:410 E LINCOLN HWY STE 101
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1976
Practice Address - Country:US
Practice Address - Phone:815-462-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025045207QA0505X
IL0361173072082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine