Provider Demographics
NPI:1518096015
Name:CANLI, URSULA S (NP)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:S
Last Name:CANLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:S
Other - Last Name:BALDOCEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4795
Mailing Address - Country:US
Mailing Address - Phone:312-413-7605
Mailing Address - Fax:312-355-1515
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-413-7605
Practice Address - Fax:312-355-1515
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner