Provider Demographics
NPI:1477807196
Name:SCIACCHITANO, MIRIAM E (APN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:E
Last Name:SCIACCHITANO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E CHICAGO AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2697
Mailing Address - Country:US
Mailing Address - Phone:312-943-0282
Mailing Address - Fax:
Practice Address - Street 1:211 E CHICAGO AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2697
Practice Address - Country:US
Practice Address - Phone:312-943-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009834363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health