Healthcare Provider Details

I. General information

NPI: 1184507014
Provider Name (Legal Business Name): MARGARET ROSE O'CALLAGHAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 111TH ST
CHICAGO IL
60628-4215
US

IV. Provider business mailing address

8943 S 84TH AVE
HICKORY HILLS IL
60457-1305
US

V. Phone/Fax

Practice location:
  • Phone: 773-768-5000
  • Fax:
Mailing address:
  • Phone: 708-822-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209032753
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: