Healthcare Provider Details

I. General information

NPI: 1790240281
Provider Name (Legal Business Name): MARGARET SIMMONS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET A O'DONNELL

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N CALIFORNIA AVE STE 603
CHICAGO IL
60625-8564
US

IV. Provider business mailing address

461 BERKSHIRE LN
DES PLAINES IL
60016-1017
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-3627
  • Fax: 773-293-8824
Mailing address:
  • Phone: 773-628-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041352309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: