Healthcare Provider Details

I. General information

NPI: 1427792027
Provider Name (Legal Business Name): NICOLE MCFARLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 07/18/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST # 3200W
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

180 N ADA ST APT 811
CHICAGO IL
60607-1544
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4020
  • Fax:
Mailing address:
  • Phone: 608-799-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.025519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: