Fagadore, Mariaelena J.

Fagadore, Mariaelena J. is an individual health care provider with primary practice located at 4254 W 55Th St , Chicago IL 60632-4642. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Fagadore, Mariaelena J. can be contacted via phone (773) 582-5200.

Contact Information

Primary practice address
4254 W 55Th St Chicago IL 60632-4642
Phone: (773) 582-5200
Fax: (773) 582-2772
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Pediatrics 163WP0200X R45506 New Mexico
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 9244538 Florida
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 209-015320 Illinois

Profile Details

NPI number 1861490138
LBN Legal business name Fagadore, Mariaelena J.
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Apr 11th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861490138 NPPES
Florida MEDICAID 307963500
Florida MEDICAID 92187315

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