Provider Demographics
NPI:1316251176
Name:DERYLO, MARIA (DNP MSN ANP BC)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:DERYLO
Suffix:
Gender:F
Credentials:DNP MSN ANP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E SCHILLER ST STE 318
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2823
Mailing Address - Country:US
Mailing Address - Phone:630-832-1775
Mailing Address - Fax:
Practice Address - Street 1:1924 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5020
Practice Address - Country:US
Practice Address - Phone:847-975-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007922363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health