MEDICARE: MS. MARY NOREEN MCHALE APN PMHNP-BC AOCN

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	163W00000X	Registered Nurse	041170279	IL
2	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	209009540	IL

General Provider Information

NPI Number	:	1518212323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY NOREEN MCHALE APN PMHNP-BC AOCN

Provider Business Mailing Address
First Line	:	2000 W BERWYN AVE
Second Line	:	UNIT 203
City	:	CHICAGO
State	:	IL
Zip	:	60625-1199
Country	:	US
Telephone Number	:	773-620-7624
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 W BERWYN AVE
Second Line	:	UNIT 203
City	:	CHICAGO
State	:	IL
Zip	:	60625-1199
Country	:	US
Telephone Number	:	773-620-7624
Fax Number	:

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

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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