Provider Demographics
NPI:1548494255
Name:REYES, MARIA R (PHD, WHNP, CNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:R
Last Name:REYES
Suffix:
Gender:F
Credentials:PHD, WHNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10824 S KOLMAR AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5619
Mailing Address - Country:US
Mailing Address - Phone:708-424-0053
Mailing Address - Fax:312-942-2822
Practice Address - Street 1:1645 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3276
Practice Address - Country:US
Practice Address - Phone:312-942-2777
Practice Address - Fax:312-942-2822
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.001736363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.001736OtherAPN LICENSURE
ILREY104282734OtherNCC CERTIFICATION