Healthcare Provider Details

I. General information

NPI: 1689291825
Provider Name (Legal Business Name): ENDIA V MCDONALD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2020
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 N. BROADWAY STREET SUITES 900, 910, 925
CHICAGO IL
60640
US

IV. Provider business mailing address

4753 N BROADWAY ST STE 910925
CHICAGO IL
60640-5266
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-2780
  • Fax: 773-989-2781
Mailing address:
  • Phone: 773-989-2780
  • Fax: 815-720-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041449535
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024900
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209024900
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: