Provider Demographics
NPI:1811222086
Name:ANTOS, MARY (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ANTOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 S KOMENSKY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4140
Mailing Address - Country:US
Mailing Address - Phone:708-684-4969
Mailing Address - Fax:708-684-1242
Practice Address - Street 1:10002 S KOMENSKY AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4140
Practice Address - Country:US
Practice Address - Phone:708-684-4969
Practice Address - Fax:708-684-1242
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.005136163WP0809X
IL041.241416163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult