Healthcare Provider Details

I. General information

NPI: 1245588961
Provider Name (Legal Business Name): FALLON M FLOWERS APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 S COTTAGE GROVE AVE
CHICAGO IL
60637-2530
US

IV. Provider business mailing address

9631 S CICERO AVE # 1331
OAK LAWN IL
60453-3137
US

V. Phone/Fax

Practice location:
  • Phone: 312-682-6110
  • Fax:
Mailing address:
  • Phone: 773-389-6696
  • Fax: 336-915-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number041.397175
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209017136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: