Active NPI
Nicole Christine Mitros, FNP-BC
- Family Nurse Practitioner
- Willowbrook, IL
National Provider Identifier
1154924827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209022218
- Practice address
- 40 75TH St
Willowbrook, IL 60527-2325 - Phone
- (630) 581-5372
- NPI assigned
- Nov 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209022218 | IL | |
| Family Nurse Practitioner | 363LF0000X | 209022218 | IL | Primary |
Addresses
Primary practice location
40 75TH St
Willowbrook, IL 60527-2325
Mailing address
40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209022218 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paragon Clinical Midwest, LLC | Nurse Practitioner | Past | Accepting new patients |
| Osf Multi-Specialty Group | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1922445527
-
- Nurse Practitioner
- Merrillville, IN
- NPI 1619335700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677801600000",
"number": "1154924827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 75TH ST",
"city": "WILLOWBROOK",
"state": "IL",
"postal_code": "605272325",
"telephone_number": "630-581-5372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 75TH ST",
"city": "WILLOWBROOK",
"state": "IL",
"postal_code": "605272325",
"telephone_number": "630-581-5372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITROS",
"first_name": "NICOLE",
"middle_name": "CHRISTINE",
"name_prefix": "Miss",
"credential": "FNP-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-17",
"last_updated": "2023-03-03",
"certification_date": "2023-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209022218",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209022218",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willowbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.