Healthcare Provider Details

I. General information

NPI: 1649220534
Provider Name (Legal Business Name): MAUREEN CROWLEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE UNIVERSITY OF CHICAGO MEDICAL CENTER
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

5841 S MARYLAND AVE RM E102
CHICAGO IL
60637-1443
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-4851
  • Fax: 773-834-3888
Mailing address:
  • Phone: 773-702-1865
  • Fax: 773-834-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209-000503
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: