Healthcare Provider Details

I. General information

NPI: 1154674380
Provider Name (Legal Business Name): COLLEEN R BLACKBURN APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN R SCHAIDLE APRN, CNP

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 SOUTH FIRST AVE LOYOLA UNIVERSITY MEDICAL CENTER
MAYWOOD IL
60153
US

IV. Provider business mailing address

PSC 2 BOX 8509
APO AE
09012-0035
US

V. Phone/Fax

Practice location:
  • Phone: 888-584-7888
  • Fax:
Mailing address:
  • Phone: 4915158832446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.009841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: