Healthcare Provider Details

I. General information

NPI: 1003570045
Provider Name (Legal Business Name): ATHENA CROWLEY APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5620
  • Fax: 312-695-2729
Mailing address:
  • Phone: 312-695-5620
  • Fax: 312-695-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2328288
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209031824
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: