Healthcare Provider Details

I. General information

NPI: 1720332125
Provider Name (Legal Business Name): RENEA CHRISTINE MCKEOWN APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST POB SUITE 407
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

4440 WEST 95TH STREET OUTPATIENT PAVILION, 6TH FLOOR
OAK LAWN IL
60453
US

V. Phone/Fax

Practice location:
  • Phone: 877-684-4327
  • Fax:
Mailing address:
  • Phone: 877-684-4327
  • Fax: 708-520-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209-009819
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209.009819
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: