Provider Demographics
NPI:1619306362
Name:MASTERS, COLLEEN MARGARET (MSN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARGARET
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARGARET
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 S PAULINA ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3804
Mailing Address - Country:US
Mailing Address - Phone:312-563-4514
Mailing Address - Fax:312-563-2857
Practice Address - Street 1:500 S PAULINA ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-563-4514
Practice Address - Fax:312-563-2857
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041369961163W00000X
IL209.010761363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse