Provider Demographics
NPI:1295150829
Name:URIBE, SIMONA (NP-C)
Entity type:Individual
Prefix:
First Name:SIMONA
Middle Name:
Last Name:URIBE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SIMONA
Other - Middle Name:
Other - Last Name:MURESAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2304 N MOODY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2732
Mailing Address - Country:US
Mailing Address - Phone:773-552-1752
Mailing Address - Fax:
Practice Address - Street 1:5002 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4127
Practice Address - Country:US
Practice Address - Phone:773-379-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009577363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health