Provider Demographics
NPI:1477688737
Name:DERRIG, NANCY JEANNE (CNM, APN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEANNE
Last Name:DERRIG
Suffix:
Gender:F
Credentials:CNM, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 LAKE STREET
Mailing Address - Street 2:SUITE L 140
Mailing Address - City:RIVER FORES
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1350
Mailing Address - Country:US
Mailing Address - Phone:708-763-5540
Mailing Address - Fax:708-383-2324
Practice Address - Street 1:7339 MADISON ST
Practice Address - Street 2:WOMEN'S HEALTH CENTER
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1543
Practice Address - Country:US
Practice Address - Phone:708-386-2400
Practice Address - Fax:708-366-7035
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNONEOtherIN THE PROCESS OF CREDENT