Provider Demographics
NPI:1033646773
Name:AVILA-CANTORE, MARY ANN (APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:AVILA-CANTORE
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:AVILA
Other - Last Name:CANTORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN, FNP-C
Mailing Address - Street 1:5020 W DAKIN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2608
Mailing Address - Country:US
Mailing Address - Phone:773-456-3526
Mailing Address - Fax:
Practice Address - Street 1:332 S MICHIGAN AVE
Practice Address - Street 2:1100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4434
Practice Address - Country:US
Practice Address - Phone:888-660-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041354359163W00000X
IL209015285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse