Basic Information
| Provider Information | |||||||||
| NPI: | 1285727115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATESKI-PRICE | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | L. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6117 N OZARK AV | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737751871 | ||||||||
| FaxNumber: | 4843513800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 MAPLE RD | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157401200 | ||||||||
| FaxNumber: | 4843513800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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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 | 363LF0000X | 209005234 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 16791834 | 05 | IL | MEDICAID |