Provider Demographics
NPI:1396410023
Name:NEAL, JUSTIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:NEAL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5236
Mailing Address - Country:US
Mailing Address - Phone:773-232-2300
Mailing Address - Fax:773-232-2301
Practice Address - Street 1:1540 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5236
Practice Address - Country:US
Practice Address - Phone:773-232-2300
Practice Address - Fax:773-232-2301
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily