Provider Demographics
NPI:1720547383
Name:RIOS, JOANNA MICHELE (APRN)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MICHELE
Last Name:RIOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MICHELE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 WINFIELD RD
Mailing Address - Street 2:CENTRALIZED SERVICES 4TH FL
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:331-221-2356
Practice Address - Street 1:303 W LAKE ST STE 200
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2500
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner