Healthcare Provider Details

I. General information

NPI: 1649449950
Provider Name (Legal Business Name): ELIZABETH ANN NANNEY APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W. HARRISON 708 KELLOGG
CHICAGO IL
60612
US

IV. Provider business mailing address

3145 176TH ST
LANSING IL
60438-1960
US

V. Phone/Fax

Practice location:
  • Phone: 312-593-7489
  • Fax:
Mailing address:
  • Phone: 312-593-7489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209006541
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209006541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: