Provider Demographics
NPI:1306559604
Name:RAIZ, MAUREEN PASCUAL (APN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:PASCUAL
Last Name:RAIZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-1938
Mailing Address - Country:US
Mailing Address - Phone:708-856-5660
Mailing Address - Fax:630-328-0144
Practice Address - Street 1:55 E LOOP RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-1938
Practice Address - Country:US
Practice Address - Phone:884-287-8908
Practice Address - Fax:877-428-7891
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026640363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health