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General NPI Number Information
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NPI Number | 1518468727
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Entity Type | Individual
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Provider Name | CONNIE MAAS
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Gender | Female
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 2955 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2409
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Country | US
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Telephone | 331-814-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 10618 S TALMAN AVE
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City | CHICAGO
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State | IL
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Zip | 60655-1705
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Country | US
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Telephone | 708-837-1715
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.016800
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209016800
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License Number State | IL
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