Healthcare Provider Details

I. General information

NPI: 1841918232
Provider Name (Legal Business Name): COLLEEN ANNMARIE CHIERICI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 STATE RD
BURBANK IL
60459-2051
US

IV. Provider business mailing address

4320 ELM AVE
BROOKFIELD IL
60513-2302
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-9200
  • Fax:
Mailing address:
  • Phone: 708-691-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: