MEDICARE: PAMELA G CIANCI APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	209001840	IL

General Provider Information

NPI Number	:	1043433600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA G CIANCI APN

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1156
City	:	CHICAGO
State	:	IL
Zip	:	60612-3244
Country	:	US
Telephone Number	:	312-942-5458
Fax Number	:	311-942-3666

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1156
City	:	CHICAGO
State	:	IL
Zip	:	60612-3244
Country	:	US
Telephone Number	:	312-942-5458
Fax Number	:	311-942-3666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	02/17/2010

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