Provider Demographics
NPI:1790076495
Name:MILOTA, MAUREEN M (FPA APRN)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:M
Last Name:MILOTA
Suffix:
Gender:F
Credentials:FPA APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 N LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4115
Mailing Address - Country:US
Mailing Address - Phone:321-659-7609
Mailing Address - Fax:
Practice Address - Street 1:3000 DUNDEE RD STE 313
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-383-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily