Provider Demographics
NPI:1992089742
Name:RAMIREZ-TASIGCHANA, KIMBERLY (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:RAMIREZ-TASIGCHANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MAIN
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053
Mailing Address - Country:US
Mailing Address - Phone:847-962-4050
Mailing Address - Fax:844-269-6718
Practice Address - Street 1:2106 GRAND AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3416
Practice Address - Country:US
Practice Address - Phone:224-381-7672
Practice Address - Fax:844-269-6781
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992089742Medicaid