Healthcare Provider Details

I. General information

NPI: 1114024916
Provider Name (Legal Business Name): DEBORAH A AARON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W JACKSON BLVD
CHICAGO IL
60604-3589
US

IV. Provider business mailing address

700 W MELROSE ST
CHICAGO IL
60657-3418
US

V. Phone/Fax

Practice location:
  • Phone: 877-279-5960
  • Fax:
Mailing address:
  • Phone: 773-230-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001848
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: