Healthcare Provider Details

I. General information

NPI: 1619306362
Provider Name (Legal Business Name): COLLEEN MARGARET MASTERS M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN MARGARET MCGUIRE

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S PAULINA ST GROUND FLOOR
CHICAGO IL
60612
US

IV. Provider business mailing address

500 S PAULINA ST GROUND FLOOR
CHICAGO IL
60612-3804
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-4514
  • Fax: 312-563-2857
Mailing address:
  • Phone: 312-563-4514
  • Fax: 312-563-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041369961
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.010761
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: