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General NPI Number Information
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NPI Number | 1841701075
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Entity Type | Individual
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Provider Name | ASHLEY BLACK APN
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Gender | Female
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 6501 S PROMONTORY DR
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City | CHICAGO
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State | IL
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Zip | 60649-1003
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Country | US
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Telephone | 773-256-5746
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 S MICHIGAN AVE APT 215
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City | CHICAGO
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State | IL
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Zip | 60605-2956
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Country | US
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Telephone | 708-218-7694
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209015210
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209015210
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 209015210
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License Number State | IL
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