Provider Demographics
NPI:1891461109
Name:TENEDOR, ALAINE GOROSPE (NP)
Entity Type:Individual
Prefix:
First Name:ALAINE
Middle Name:GOROSPE
Last Name:TENEDOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 KENICOTT CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-4179
Mailing Address - Country:US
Mailing Address - Phone:773-319-2999
Mailing Address - Fax:
Practice Address - Street 1:161 S LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1658
Practice Address - Country:US
Practice Address - Phone:630-906-3700
Practice Address - Fax:630-906-0730
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty