Healthcare Provider Details

I. General information

NPI: 1386391936
Provider Name (Legal Business Name): ROBYN MCCLELLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N CLARK ST
CHICAGO IL
60610-2702
US

IV. Provider business mailing address

3637 N SOUTHPORT AVE
CHICAGO IL
60613-3709
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-5282
  • Fax:
Mailing address:
  • Phone: 773-348-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030316
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2309177
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.026680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: