Basic Information
| Provider Information | |||||||||
| NPI: | 1265712947 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FUENTES | ||||||||
| FirstName: | CONSUELO | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | SHRINERS HOSPITAL FOR CHILDREN CHICAGO | ||||||||
| Address2: | PO BOX 8500 LOCKBOX 7642 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191787642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132818115 | ||||||||
| FaxNumber: | 8132818656 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 N OAK PARK AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607073351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736225400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2011 | ||||||||
| LastUpdateDate: | 03/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 209008706 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.