Basic Information
| Provider Information | |||||||||
| NPI: | 1265034201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAMILARA | ||||||||
| FirstName: | CHERRY | ||||||||
| MiddleName: | MAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 BLUEBERRY LN | ||||||||
| Address2: | |||||||||
| City: | ROUND LAKE BEACH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600734937 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1324 N SHERIDAN RD | ||||||||
| Address2: | |||||||||
| City: | WAUKEGAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600852161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473603000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2020 | ||||||||
| LastUpdateDate: | 11/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 041400903 | IL | Y | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.