Provider Demographics
NPI:1679116651
Name:ALVAREZ, TERESA L (LPN)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:L
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:COLANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:140 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1802
Mailing Address - Country:US
Mailing Address - Phone:312-850-0500
Mailing Address - Fax:312-850-9095
Practice Address - Street 1:140 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1802
Practice Address - Country:US
Practice Address - Phone:312-850-0500
Practice Address - Fax:312-850-9095
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043112496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse