MEDICARE: MAUREEN C DUFFY RN WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209001555	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209001555	OTHER	IL	NP
2	277000175	OTHER	IL	STATE LICENSE
3	041200079	OTHER	IL	PROF LIC

General Provider Information

NPI Number	:	1114916269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN C DUFFY RN WHNP

Provider Business Mailing Address
First Line	:	355 W NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2414
Country	:	US
Telephone Number	:	847-221-4700
Fax Number	:	847-221-4796

Provider Business Practice Location Address
First Line	:	355 W NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2414
Country	:	US
Telephone Number	:	847-221-4700
Fax Number	:	847-221-4796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	06/04/2021

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