MEDICARE: CAITLIN ANNE MAYS APN, AGPCNP-BC

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	363LG0600X	Gerontology Nurse Practitioner	209019132	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041410492	OTHER	IL	STATE RN

General Provider Information

NPI Number	:	1972167914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ANNE MAYS APN, AGPCNP-BC

Provider Business Mailing Address
First Line	:	2050 CLAIRE CT
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-7635
Country	:	US
Telephone Number	:	847-467-7423
Fax Number	:	847-556-1715

Provider Business Practice Location Address
First Line	:	549 W RANDOLPH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-2208
Country	:	US
Telephone Number	:	224-770-2424
Fax Number	:	847-556-1715

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/25/2019

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