Provider Demographics
NPI:1538599782
Name:RAGUSA, MARIA A (CPN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:RAGUSA
Suffix:
Gender:F
Credentials:CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 DOTY RD STE H
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7530
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:811-533-7549
Practice Address - Street 1:3707 DOTY RD STE H
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:811-533-7549
Is Sole Proprietor?:No
Enumeration Date:2013-11-24
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010997363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209010997OtherSTATE LICENSE