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General NPI Number Information
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NPI Number | 1013273374
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Entity Type | Individual
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Provider Name | MARY PATRICIA KO APN NURSE PRACTITION
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Gender | Female
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 3800 N. CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60618
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Country | US
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Telephone | 773-478-4222
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Fax | 773-478-7867
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Provider Business Mailing Address
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Address Line | 1333 BURR RIDGE PKWY SUITE 200
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City | BURR RIDGE
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State | IL
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Zip | 60527
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Country | US
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Telephone | 630-832-1775
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Fax | 630-832-3078
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP60270270
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License Number State | WA
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