Basic Information
| Provider Information | |||||||||
| NPI: | 1366508053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARAUZ | ||||||||
| FirstName: | YETZENIA | ||||||||
| MiddleName: | ARAMIS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2568 NORTH 41ST STREET | ||||||||
| Address2: | |||||||||
| City: | FAIRMONT CITY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184824015 | ||||||||
| FaxNumber: | 6184824806 | ||||||||
| Practice Location | |||||||||
| Address1: | 2568 NORTH 41ST STREET | ||||||||
| Address2: | |||||||||
| City: | FAIRMONT CITY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184824015 | ||||||||
| FaxNumber: | 6184824806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041290396 | IL | N | Nursing Service Providers | Registered Nurse | 363L00000X | 209002371 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.