Provider Demographics
NPI:1124267851
Name:RESCOBER, TERESITA MENDOZA (RN-ADVPRACT/CSP)
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:MENDOZA
Last Name:RESCOBER
Suffix:
Gender:F
Credentials:RN-ADVPRACT/CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3714
Mailing Address - Country:US
Mailing Address - Phone:312-864-4267
Mailing Address - Fax:312-864-9553
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-4267
Practice Address - Fax:312-864-9553
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-142384163WP1700X, 163WD0400X, 163WN0002X, 163WX0003X
IL163W00000X163W00000X
IL209.001313364SP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatal