Provider Demographics
NPI:1285864256
Name:CREAN, MARY B (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:CREAN
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:FITZMAURICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12251 S 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1290
Mailing Address - Country:US
Mailing Address - Phone:708-923-5869
Mailing Address - Fax:708-923-5859
Practice Address - Street 1:12251 S. 80TH AVENUE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:630-257-1111
Practice Address - Fax:708-923-5018
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000511363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400289952OtherMEDICARE PTAN
ILF400289952OtherMEDICARE PTAN
IL615318700OtherUS DEPT OF LABOR - 2222 W DIVISION LOCATION
IL615318701OtherUS DEPT OF LABOR - 2001 S CALIFORNIA LOCATION