Mariaelena J. Fagadore, CNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209-015320 Issued in IL

Practice address

4254 W 55TH St
Chicago, IL 60632-4642

Phone

(773) 582-5200

Fax

(773) 582-2772

NPI assigned

Jul 12, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491868800000",
    "number": "1861490138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4254 W 55TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606324642",
            "telephone_number": "773-582-5200",
            "fax_number": "773-582-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4254 W 55TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606324642",
            "telephone_number": "773-582-5200",
            "fax_number": "773-582-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGADORE",
        "first_name": "MARIAELENA",
        "middle_name": "J.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2017-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "NM",
            "license": "R45506",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "9244538",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209-015320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307963500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "92187315",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Rose Fadowole
• Olayinka Stephen Fadowole, PHARMD
• Colin Fadzen, MD PHD
• Danette Fadzl, MEDICAL BILLING
• Patricia Faerber, PT, DPT
• Brian J Fagan
• Eilis M Fagan, LCSW
• Elyse Fagan, CNS, IBCLC
• Marc Fagan, PSY.D.
• Mitchell Fagan, DO

• Pediatric Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.