MEDICARE: MRS. EMILY ANNA NASH FNP-BC

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	363LF0000X	Family Nurse Practitioner	209.032970	IL

General Provider Information

NPI Number	:	1861174641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY ANNA NASH FNP-BC

Provider Business Mailing Address
First Line	:	625 W BUCKINGHAM PL APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-0405
Country	:	US
Telephone Number	:	518-231-1986
Fax Number	:

Provider Business Practice Location Address
First Line	:	331 W SURF ST STE 902
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7227
Country	:	US
Telephone Number	:	773-904-8641
Fax Number	:	872-888-1206

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	05/29/2026

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