PRESENCE PROVISO FAMILY SERVICES INC (NPI# 1235411703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235411703 |
| Entity Type | Organization |
| Organization Name | PRESENCE PROVISO FAMILY SERVICES INC |
| Other Organization Name | PROVISO FAMILY SERVICES INC |
| Practice Address |
2940 N Ashland Ave Chicago IL 60657-4004 |
| Mailing Address |
1000 Remington Boulevard Suite 100 Bolingbrook IL 60440-0000 |
| Practice Telephone | 7735254440 |
| Practice Fax Number | 7735257771 |
| Mailing Telephone | 6309142417 |
| Mailing Fax Number | 6309142499 |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2013-04-09 |
| Authorized Official Name | MRS. MELVONNE WICKLIFFE-JONES (CREDENTIALING MGR) |
| Authorized Official Telephone | 6309142417 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
IL | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Proviso Family Services Inc | Doing Business As Name - Organization |
| Street Address |
2940 N ASHLAND AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60657-4004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720034648 | American Drug Stores LLC | Durable Medical Equipment & Medical Supplies | 2940 N Ashland Ave, Chicago, IL 60657 | 2006-05-25 |
| 1043668759 | Jennifer Torres | Pharmacist | 2940 N Ashland Ave, Chicago, IL 60657-4004 | 2016-06-03 |
| 1841649548 | Kenneth Lee | Pharmacist | 2940 N Ashland Ave, Chicago, IL 60657-4004 | 2016-06-03 |
| 1013364280 | Andrew Ly | Pharmacist | 2940 N Ashland Ave, Chicago, IL 60657-4004 | 2016-05-18 |
| 1942657440 | Manisha Patel | Pharmacist | 2940 N Ashland Ave, Chicago, IL 60657-4004 | 2016-05-16 |
| 1336595479 | Edisorn Pardungkiattisak | Pharmacist | 2940 N Ashland Ave, Chicago, IL 60657-4004 | 2016-05-08 |
| 1265808216 | Matthew Siena | Pharmacist | 2940 N Ashland Ave, Chicago, IL 60657-4004 | 2015-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303887 | Simone Paes | Behavior Technician | 3141 N Sheffield Ave, Chicago, IL 60657 | 2020-10-13 |
| 1821613175 | Samridhi Khatri | Internal Medicine | 836 W. Wellington Ave, Advocate Illinois Masonic Medica, Suite 1312, Chigaco, IL 60657 | 2020-06-12 |
| 1467074617 | Dewolfe Aesthetic Services Sc | Surgery | 3357 N. Southport Aveune, Chicago, IL 60657 | 2020-05-11 |
| 1790304657 | Mehr Amer Mjeed | Student in an Organized Health Care Education/Training Program | Advocate Internal Medicine Clinic, Advocate Illinois Ma, 836 West Wellington Avenue, Chicago, IL 60657 | 2020-04-10 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1306493408 | Art of Sight Eyecare, LLC | Optometrist | 2915 N. Broadway, Chicago, IL 60657 | 2019-08-22 |
| 1992359277 | Joseph Michael Rochford IIi | Counselor | 1358 W Belmont Ave, Unit # 202, Chicago, IL 60657 | 2019-07-25 |
| 1487116240 | Conrad Petersen Dermatology Sc | Dermatology | 2845 N Sheridan, Chicago, IL 60657 | 2019-04-02 |
| 1003388810 | Evolve Wellness S.c. | Counselor | 2845 North Sheridan Road, Suite 708, Chicago, IL 60657 | 2018-12-19 |
| 1639657414 | Advocate North Side Health Network | Psychiatric Unit | 836 W Wellington Ave., Chicago, IL 60657 | 2018-08-02 |
| Find all providers in zip 60657 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700911 | Laura Ivette Portillo | Nurse Practitioner | 2727 N Marmora Ave, Chicago, IL 60639-1219 | 2020-11-05 |
| 1265033385 | Carolle M Derradji | Nurse Practitioner | 3256 W Potomac Ave, Chicago, IL 60651-2411 | 2020-11-04 |
| 1104427293 | Katie Michelle O'halloran | Nurse Practitioner | 5841 S Maryland Ave # E500, Chicago, IL 60637-1443 | 2020-11-04 |
| 1578163515 | Deanna Bassette | Nurse Practitioner | 243 E 31st St Apt 401, Chicago, IL 60616-5212 | 2020-10-29 |
| 1891395745 | Vrunda Shah Patel | Nurse Practitioner | 933 W Van Buren St Apt 502, Chicago, IL 60607-3583 | 2020-10-29 |
| 1881291706 | Rita Elue | Nurse Practitioner | 6241 N Winthrop Ave Apt 307, Chicago, IL 60660-2071 | 2020-10-04 |
| 1558976514 | Janice Nicole Kinney | Nurse Practitioner | 10127 S Harding Ave, Chicago, IL 60655-3748 | 2020-09-15 |
| 1881209278 | Monique Graves | Nurse Practitioner | 4912 W Adams St Apt 2, Chicago, IL 60644-4445 | 2020-09-11 |
| 1194339721 | Maureen Iyesogie Diji | Nurse Practitioner | 4658 S Ellis Ave, Chicago, IL 60653-3625 | 2020-09-01 |
| 1669085395 | Emily Calderon | Nurse Practitioner | 5556 N Sheridan Rd Apt 506, Chicago, IL 60640-1677 | 2020-08-24 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.