| Advanced Practice Network, Llc | |
|
1444 W 74th St Chicago IL 60636-4028 | |
| (773) 709-6679 | |
| Not Available |
| Full Name | Advanced Practice Network, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1444 W 74th St, Chicago, Illinois |
| Authorized Official Name and Position | Shelia Lavette Martin (PRESIDENT) |
| Authorized Official Contact | 7737096679 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Practice Network, Llc 1444 W 74th St Chicago IL 60636-4028 Ph: (773) 709-6679 | Advanced Practice Network, Llc 1444 W 74th St Chicago IL 60636-4028 Ph: (773) 709-6679 |
| NPI Number | 1790401701 |
|---|---|
| Provider Enumeration Date | 10/12/2022 |
| Last Update Date | 05/17/2023 |
| Medicare PECOS PAC ID | 6305201161 |
|---|---|
| Medicare Enrollment ID | O20230501000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790401701 | NPI | - | NPPES |
| 1154820413 | Other | IL | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Shelia Lavette Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154820413 PECOS PAC ID: 1355698556 Enrollment ID: I20180719000178 |
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