Healthcare Provider Details

I. General information

NPI: 1366316077
Provider Name (Legal Business Name): ASHLEY LAUREN MAZZOCCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

1313 N RITCHIE CT APT 1907
CHICAGO IL
60610-5101
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone: 847-873-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number041500581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: