Healthcare Provider Details

I. General information

NPI: 1598466203
Provider Name (Legal Business Name): CLAIRE ELIZABETH MACINO AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST STE 11-140
CHICAGO IL
60611-2968
US

IV. Provider business mailing address

201 E HURON ST STE 11-140
CHICAGO IL
60611-2968
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-7140
  • Fax: 312-707-2467
Mailing address:
  • Phone: 312-926-7140
  • Fax: 312-707-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027288
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209027288
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041453330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: