Provider Demographics
NPI:1194411918
Name:MACALAGUIN, GRACE VICTORIA SY (LPN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:VICTORIA SY
Last Name:MACALAGUIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:VICTORIA
Other - Last Name:SY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3001 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-8632
Mailing Address - Fax:224-610-8638
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-8632
Practice Address - Fax:224-610-8638
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043116912164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse