Healthcare Provider Details

I. General information

NPI: 1043541766
Provider Name (Legal Business Name): ALLYSON NICOLE WARD NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

4008 N SOUTHPORT AVENUE UNIT #1
CHICAGO IL
60613-2200
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-2000
  • Fax:
Mailing address:
  • Phone: 317-750-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209010261
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: