Provider Demographics
NPI:1114916269
Name:DUFFY, MAUREEN C (RN WHNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:C
Last Name:DUFFY
Suffix:
Gender:F
Credentials:RN WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2414
Mailing Address - Country:US
Mailing Address - Phone:847-221-4700
Mailing Address - Fax:847-221-4796
Practice Address - Street 1:355 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2414
Practice Address - Country:US
Practice Address - Phone:847-221-4700
Practice Address - Fax:847-221-4796
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001555363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209001555OtherNP
IL277000175OtherSTATE LICENSE
IL041200079OtherPROF LIC