Healthcare Provider Details

I. General information

NPI: 1366336000
Provider Name (Legal Business Name): REYGAN TAWNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MICHIGAN AVE STE 1550
CHICAGO IL
60604-2424
US

IV. Provider business mailing address

200 S MICHIGAN AVE STE 1550
CHICAGO IL
60604-2424
US

V. Phone/Fax

Practice location:
  • Phone: 312-263-5517
  • Fax:
Mailing address:
  • Phone: 312-263-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.036226
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209036226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: