Healthcare Provider Details

I. General information

NPI: 1346050317
Provider Name (Legal Business Name): MICHELLE HARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE # 164
CHICAGO IL
60649-3954
US

IV. Provider business mailing address

1831 RIVER OAKS DR
CALUMET CITY IL
60409-5071
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-2831
  • Fax:
Mailing address:
  • Phone: 708-297-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030771
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: