Healthcare Provider Details

I. General information

NPI: 1396228417
Provider Name (Legal Business Name): HOPE FAIRCLOUGH MCGOWAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 04/16/2019
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

2019 THORNWOOD AVE
WILMETTE IL
60091-1450
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6340
  • Fax: 312-227-9412
Mailing address:
  • Phone: 847-609-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.018104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: