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General NPI Number Information
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NPI Number | 1184229429
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Entity Type | Individual
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Provider Name | ANN M WALDRON APN
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Gender | Female
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 20939 S CICERO AVE
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City | MATTESON
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State | IL
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Zip | 60443-1620
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Country | US
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Telephone | 708-679-2370
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Fax |
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Provider Business Mailing Address
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Address Line | 35318 EAGLE WAY
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City | CHICAGO
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State | IL
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Zip | 60678-1353
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209022463
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209022463
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 277003378
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License Number State | IL
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