Healthcare Provider Details

I. General information

NPI: 1285620898
Provider Name (Legal Business Name): LYNN M HEALD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W FULLERTON AVE BOX 155
CHICAGO IL
60614-2680
US

IV. Provider business mailing address

705 S TAYLOR AVE
OAK PARK IL
60304-1623
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4666
  • Fax:
Mailing address:
  • Phone: 773-880-4666
  • Fax: 773-975-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number209-005553
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: