Healthcare Provider Details

I. General information

NPI: 1952522534
Provider Name (Legal Business Name): NANCY M MCDERMOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 S. HARLEM AVE. STE 202 LL
NORTH RIVERSIDE IL
60546
US

IV. Provider business mailing address

2368 PAYSPHERE CIRLCE
CHICAGO IL
60674
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-7840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: