Provider Demographics
NPI:1972174688
Name:ACEVEDO, MINA LEE (APRN)
Entity Type:Individual
Prefix:MS
First Name:MINA
Middle Name:LEE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2180 PFINGSTEN RD # 2000
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1339
Mailing Address - Country:US
Mailing Address - Phone:847-570-2570
Mailing Address - Fax:847-570-2073
Practice Address - Street 1:2180 PFINGSTEN RD # 2000
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1339
Practice Address - Country:US
Practice Address - Phone:847-570-2570
Practice Address - Fax:847-570-2073
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.0234092085R0204X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily