Provider Demographics
NPI:1811647829
Name:PHILIZAIRE CAMACHO, REGINE (APRN, MSN, AGPCNP-C)
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:PHILIZAIRE CAMACHO
Suffix:
Gender:F
Credentials:APRN, MSN, AGPCNP-C
Other - Prefix:
Other - First Name:REGINE
Other - Middle Name:PHILIZAIRE
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, MSN, AGPCNP-C
Mailing Address - Street 1:6352 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1213
Mailing Address - Country:US
Mailing Address - Phone:872-208-3095
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST STE 1950
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3907
Practice Address - Country:US
Practice Address - Phone:312-926-3185
Practice Address - Fax:312-926-7382
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024946363LA2200X
IL209024946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health