Provider Demographics
NPI:1174567028
Name:KOMPERDA, MAUREEN MARY (NP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:MARY
Last Name:KOMPERDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:MARY
Other - Last Name:TESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:802 S CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4527
Mailing Address - Country:US
Mailing Address - Phone:630-834-0957
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE AND ROOSEVELT ROAD
Practice Address - Street 2:BUILDING 200 - 3RD FLOOR
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-8358
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health