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General NPI Number Information
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NPI Number | 1629565007
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Entity Type | Individual
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Provider Name | MAGGIE GIDDENS NP
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Gender | Female
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 4318 S STATE ST
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City | CHICAGO
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State | IL
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Zip | 60609-3701
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Country | US
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Telephone | 773-285-9304
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Fax | 773-564-3501
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Provider Business Mailing Address
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Address Line | 3030 CHICAGO RD
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City | STEGER
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State | IL
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Zip | 60475-1055
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Country | US
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Telephone | 708-300-6692
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Fax | 708-756-3065
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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 | 209016970
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License Number State | IL
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