Active NPI
Vanessa Maldonado
- Registered Nurse
- Waukegan, IL
National Provider Identifier
1922491133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041415663
- Practice address
- 3002 Grand Ave
Waukegan, IL 60085-2321 - Phone
- (847) 377-8200
- NPI assigned
- Mar 12, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041415663 | IL | Primary |
Addresses
Primary practice location
3002 Grand Ave
Waukegan, IL 60085-2321
Mailing address
421 Fairlawn Dr
Round Lake Park, IL 60073-3116
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041415663 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426118400000",
"number": "1922491133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 FAIRLAWN DR",
"city": "ROUND LAKE PARK",
"state": "IL",
"postal_code": "600733116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3002 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852321",
"telephone_number": "847-377-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALDONADO",
"first_name": "VANESSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-12",
"last_updated": "2015-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041415663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.