Provider Demographics
NPI:1497096853
Name:CALLAGHAN, MARY EILEEN (APRN, CNS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:EILEEN
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 E SUPERIOR ST FL 15
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-472-4225
Mailing Address - Fax:312-472-4226
Practice Address - Street 1:250 E SUPERIOR ST FL 15
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-4225
Practice Address - Fax:312-472-4226
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009546364SX0200X
IL209009546367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology