Healthcare Provider Details

I. General information

NPI: 1972167914
Provider Name (Legal Business Name): CAITLIN ANNE MAYS APN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 W RANDOLPH ST
CHICAGO IL
60661-2208
US

IV. Provider business mailing address

2050 CLAIRE CT
GLENVIEW IL
60025-7635
US

V. Phone/Fax

Practice location:
  • Phone: 224-770-2424
  • Fax: 847-556-1715
Mailing address:
  • Phone: 847-467-7423
  • Fax: 847-556-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209019132
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: