Provider Demographics
NPI:1174215784
Name:CRUZ RAMIREZ, PAOLA D (FNP-C)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:D
Last Name:CRUZ RAMIREZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 WATERFORD RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1931
Mailing Address - Country:US
Mailing Address - Phone:630-965-0658
Mailing Address - Fax:
Practice Address - Street 1:1240 NORMAL RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1497
Practice Address - Country:US
Practice Address - Phone:815-753-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.408589163WG0000X
IL209.027864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice