Healthcare Provider Details

I. General information

NPI: 1851790786
Provider Name (Legal Business Name): ASHLEY CALANDRA MACNAMARA DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY CALANDRA DNP, FNP-BC

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 W JACKSON BLVD ROOM 110
CHICAGO IL
60612-2910
US

IV. Provider business mailing address

2245 W JACKSON BLVD ROOM 110
CHICAGO IL
60612-2910
US

V. Phone/Fax

Practice location:
  • Phone: 773-534-7582
  • Fax: 773-534-7194
Mailing address:
  • Phone: 773-534-7582
  • Fax: 773-534-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011583
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: