1417189234 NPI number — MS. MARIA ELENA ROUX RN WHNP BC

Table of content: MS. MARIA ELENA ROUX RN WHNP BC (NPI 1417189234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417189234 NPI number — MS. MARIA ELENA ROUX RN WHNP BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROUX
Provider First Name:
MARIA
Provider Middle Name:
ELENA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN WHNP BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417189234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 LAKESIDE DR STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANNOCKBURN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
475-621-4108
Provider Business Mailing Address Fax Number:
847-562-0830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1721 MOON LAKE BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60169-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-884-9800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  209007695 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)