Healthcare Provider Details

I. General information

NPI: 1356352512
Provider Name (Legal Business Name): MARY DIGATE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY O'NEILL CNS

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPALDING DR STE 400
NAPERVILLE IL
60540-6554
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-718-2660
  • Fax:
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-004031
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number209-004031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: