Healthcare Provider Details

I. General information

NPI: 1104288018
Provider Name (Legal Business Name): NICOLE APEL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1417 W SCHOOL ST
CHICAGO IL
60657-2119
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4175
  • Fax:
Mailing address:
  • Phone: 773-960-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.013037
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number630979
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.404896
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.010299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: