Provider Demographics
NPI:1376225177
Name:O'GRADY, NICOLE I (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:I
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26839 S WILDGRASS TURN
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8671
Mailing Address - Country:US
Mailing Address - Phone:773-415-0620
Mailing Address - Fax:
Practice Address - Street 1:402 TOWN CENTER RD # 500
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2300
Practice Address - Country:US
Practice Address - Phone:779-236-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily