Provider Demographics
NPI:1225319502
Name:DOERR, ABBIGAYLE MAE (APN, FNP-BC, RN)
Entity Type:Individual
Prefix:MISS
First Name:ABBIGAYLE
Middle Name:MAE
Last Name:DOERR
Suffix:
Gender:F
Credentials:APN, FNP-BC, RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE# 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-0665
Mailing Address - Fax:312-695-0050
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE# 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-695-0665
Practice Address - Fax:312-695-0050
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.009042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILF400112304OtherMEDICARE PTAN (INDIVIDUAL)
IL041341141OtherMEDICAID