Provider Demographics
NPI:1043433600
Name:CIANCI, PAMELA G (APN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:CIANCI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 1156
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3244
Mailing Address - Country:US
Mailing Address - Phone:312-942-5458
Mailing Address - Fax:311-942-3666
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 1156
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3244
Practice Address - Country:US
Practice Address - Phone:312-942-5458
Practice Address - Fax:311-942-3666
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001840363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK37205Medicare PIN