Provider Demographics
NPI:1013786540
Name:ADVINCULA, AIRA BASCO
Entity type:Individual
Prefix:MRS
First Name:AIRA
Middle Name:BASCO
Last Name:ADVINCULA
Suffix:
Gender:F
Credentials:
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:847-604-6511
Mailing Address - Fax:847-604-6708
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:847-604-6751
Practice Address - Fax:847-604-6708
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041398194163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology