Individual provider Active NPI

Roberta A. Naegele, APN

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1689813883
Registry record updated Dec 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.007467 Issued in IL
Practice address
2158 W Grand Ave
#101
Chicago, IL 60612-1571
Phone
(312) 773-9858
Fax
(815) 774-9234
NPI assigned
Feb 11, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.007467 IL Primary

Addresses

Primary practice location

2158 W Grand Ave
#101
Chicago, IL 60612-1571

Mailing address

2158 W Grand Ave
#101
Chicago, IL 60612-1571
Phone (312) 773-9858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.007467ILMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325116800000",
    "number": "1689813883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2158 W GRAND AVE",
            "address_2": "#101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121571",
            "telephone_number": "312-773-9858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 W GRAND AVE",
            "address_2": "#101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121571",
            "telephone_number": "312-773-9858",
            "fax_number": "815-774-9234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAEGELE",
        "first_name": "ROBERTA",
        "middle_name": "A.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-11",
        "last_updated": "2011-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.007467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.