Provider Demographics
NPI:1356197545
Name:CERVANTES, MONICA IRINA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:IRINA
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 W HIGHPLAINS RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4269
Mailing Address - Country:US
Mailing Address - Phone:773-430-0686
Mailing Address - Fax:
Practice Address - Street 1:465 W HIGHPLAINS RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-4269
Practice Address - Country:US
Practice Address - Phone:773-430-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023168525363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health