Provider Demographics
NPI:1871241067
Name:YU-ISIDERIO, ROSELLE CHAN (NP)
Entity type:Individual
Prefix:
First Name:ROSELLE
Middle Name:CHAN
Last Name:YU-ISIDERIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROSELLE
Other - Middle Name:CHAN
Other - Last Name:YU-ISIDERIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:342 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5021
Mailing Address - Country:US
Mailing Address - Phone:773-973-7570
Mailing Address - Fax:773-973-3055
Practice Address - Street 1:342 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5021
Practice Address - Country:US
Practice Address - Phone:847-520-8909
Practice Address - Fax:847-520-8929
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024882363L00000X, 363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209024882Medicaid
ILMY7506720OtherDEA