Provider Demographics
NPI:1386884500
Name:ALFORQUE, WENCHITA D (NP-C)
Entity type:Individual
Prefix:
First Name:WENCHITA
Middle Name:D
Last Name:ALFORQUE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W CENTRAL RD STE 40
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2477
Mailing Address - Country:US
Mailing Address - Phone:773-206-5950
Mailing Address - Fax:
Practice Address - Street 1:1700 W CENTRAL RD STE 40
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2477
Practice Address - Country:US
Practice Address - Phone:847-305-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007491363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health