Healthcare Provider Details

I. General information

NPI: 1619675345
Provider Name (Legal Business Name): MARGARET ANNE FEDENIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

933 W VAN BUREN ST APT 810
CHICAGO IL
60607-3597
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5904
  • Fax:
Mailing address:
  • Phone: 708-218-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.026282
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: