Healthcare Provider Details

I. General information

NPI: 1811144629
Provider Name (Legal Business Name): ABBY ELIZABETH MCMAHON FNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 LAKEVIEW PKWY STE 116
VERNON HILLS IL
60061-1822
US

IV. Provider business mailing address

565 LAKEVIEW PKWY STE 116
VERNON HILLS IL
60061-1822
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-7340
  • Fax:
Mailing address:
  • Phone: 847-367-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.007185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: