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NPI Code Detail

MEDICARE: LYNDA EILEEN PETTIGREW APN

MEDICARE: LYNDA EILEEN PETTIGREW 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209010016IL

General Provider Information

NPI Number : 1174869994
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNDA EILEEN PETTIGREW APN
Provider Business Mailing Address
First Line : 1442 W FULLERTON AVE
Second Line : 3A
City : CHICAGO
State : IL
Zip : 60614-2797
Country : US
Telephone Number : 773-726-2113
Fax Number :
Provider Business Practice Location Address
First Line : 5730 W ROOSEVELT RD
Second Line :
City : CHICAGO
State : IL
Zip : 60644-1580
Country : US
Telephone Number : 773-413-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2012
Last Update Date : 12/26/2012

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