Healthcare Provider Details

I. General information

NPI: 1841194438
Provider Name (Legal Business Name): AMY ANN CONNOLLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S. 5TH AVENUE BUILDING 200, 4TH FLOOR (MSSC)
HINES IL
60141-3030
US

IV. Provider business mailing address

5000 S. 5TH AVENUE BUILDING 200, 4TH FLOOR (MSSC)
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-3636
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041332325
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: