Healthcare Provider Details

I. General information

NPI: 1952359655
Provider Name (Legal Business Name): MAUREEN SLATTERLY HAUGEN APN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

1729 HIGHLAND AVE
WILMETTE IL
60091
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4090
  • Fax:
Mailing address:
  • Phone: 773-880-3244
  • Fax: 773-880-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209002130
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: