=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497096853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY EILEEN CALLAGHAN APRN, CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2013
-----------------------------------------------------
Last Update Date | 10/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 E SUPERIOR ST FL 15
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-472-4225
-----------------------------------------------------
Fax | 312-472-4226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 E SUPERIOR ST FL 15
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-472-4225
-----------------------------------------------------
Fax | 312-472-4226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Clinical Nurse Specialist
-----------------------------------------------------
License Number | 209.009546
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 209009546
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------