Healthcare Provider Details

I. General information

NPI: 1881083327
Provider Name (Legal Business Name): CATHERINE JEAN PHILLIPS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 10/22/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

IV. Provider business mailing address

3134 N CLARK ST
CHICAGO IL
60657-4414
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7032
  • Fax: 312-766-4946
Mailing address:
  • Phone: 773-296-7032
  • Fax: 773-296-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: