Healthcare Provider Details

I. General information

NPI: 1740607332
Provider Name (Legal Business Name): MAUREEN MCLACHLAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 W CHICAGO AVE
CHICAGO IL
60651-3226
US

IV. Provider business mailing address

4800 W CHICAGO AVE
CHICAGO IL
60651-3226
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-9600
  • Fax:
Mailing address:
  • Phone: 773-826-9600
  • Fax: 773-826-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041406164
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.022015
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: