Healthcare Provider Details

I. General information

NPI: 1427832062
Provider Name (Legal Business Name): ANN FAZZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

IV. Provider business mailing address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-2800
  • Fax:
Mailing address:
  • Phone: 312-227-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.028127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: