Provider Demographics
NPI:1982145967
Name:RIOS, EDNA MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:MICHELLE
Last Name:RIOS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE,
Mailing Address - Street 2:MC4080
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1448
Mailing Address - Country:US
Mailing Address - Phone:773-702-9916
Mailing Address - Fax:773-702-6972
Practice Address - Street 1:5841 S MARYLAND AVE,
Practice Address - Street 2:MC4080
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1448
Practice Address - Country:US
Practice Address - Phone:773-702-9916
Practice Address - Fax:773-702-6972
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily