Provider Demographics
NPI:1194476499
Name:ESTRADA, MA AURORA EMMA ALTUNA (AGAC-NP)
Entity type:Individual
Prefix:
First Name:MA AURORA EMMA
Middle Name:ALTUNA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:MA AURORA EMMA
Other - Middle Name:ALTUNA
Other - Last Name:ELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6901 156TH PL
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1595
Mailing Address - Country:US
Mailing Address - Phone:708-224-8386
Mailing Address - Fax:
Practice Address - Street 1:17901 GOVERNORS HWY # 209
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-960-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024349363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner