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General NPI Number Information
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NPI Number | 1639415979
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Entity Type | Individual
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Provider Name | MARY SHIELLAH BLANCAFLOR JAMES N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 3825 HIGHLAND AVE FL 4
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-719-4799
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Fax | 630-963-7420
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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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 | 28227760A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277.000750
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License Number State | IL
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