Healthcare Provider Details

I. General information

NPI: 1225960586
Provider Name (Legal Business Name): MARA HANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 1200
CHICAGO IL
60611-8702
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 1200
CHICAGO IL
60611-8702
US

V. Phone/Fax

Practice location:
  • Phone: 312-440-9400
  • Fax:
Mailing address:
  • Phone: 312-440-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209034307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: