Healthcare Provider Details

I. General information

NPI: 1922139658
Provider Name (Legal Business Name): ELLEN M. CHIOCCA APN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W LAWRENCE AVE
CHICAGO IL
60640-5017
US

IV. Provider business mailing address

9119S EXCHANGE AVE
CHICAGO IL
60617-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-275-2586
  • Fax:
Mailing address:
  • Phone: 773-768-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209003195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: