Healthcare Provider Details

I. General information

NPI: 1194241448
Provider Name (Legal Business Name): ASHLEY MARIE PALMIERI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 W 95TH ST
OAK LAWN IL
60453-2521
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-1915
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-2880
  • Fax:
Mailing address:
  • Phone: 630-469-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041394232
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.016363
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: