Provider Demographics
NPI:1871269266
Name:FAMILARA, CEAZAR ORIEL (BSN RN)
Entity Type:Individual
Prefix:
First Name:CEAZAR
Middle Name:ORIEL
Last Name:FAMILARA
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 PEMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-4222
Mailing Address - Country:US
Mailing Address - Phone:224-623-7391
Mailing Address - Fax:847-604-6753
Practice Address - Street 1:1101 PEMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4222
Practice Address - Country:US
Practice Address - Phone:224-623-7391
Practice Address - Fax:847-604-6753
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041306840163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology