Provider Demographics
NPI:1992172944
Name:DEATO, MARY CHRISTINE VILLANUEVA (RN, MSN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MARY CHRISTINE
Middle Name:VILLANUEVA
Last Name:DEATO
Suffix:
Gender:F
Credentials:RN, MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD STE 610
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3362
Mailing Address - Country:US
Mailing Address - Phone:847-981-3630
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD STE 610
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3362
Practice Address - Country:US
Practice Address - Phone:847-981-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013165363LA2200X, 363LG0600X, 363LP2300X, 363L00000X
IL209013165363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209013165OtherSTATE LICENSE