Healthcare Provider Details

I. General information

NPI: 1669465480
Provider Name (Legal Business Name): MAUREEN A MCCAFFERTY RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W 95TH ST
OAK LAWN IL
60453-2504
US

IV. Provider business mailing address

4950 W 95TH ST
OAK LAWN IL
60453-2504
US

V. Phone/Fax

Practice location:
  • Phone: 708-576-8150
  • Fax: 708-576-8831
Mailing address:
  • Phone: 708-576-8150
  • Fax: 708-576-8831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209-004103
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-204506
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: