Provider Demographics
NPI:1619468568
Name:GOLDHAR, EMILY FAE (RN, PNP-AC/PC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:FAE
Last Name:GOLDHAR
Suffix:
Gender:F
Credentials:RN, PNP-AC/PC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:FAE
Other - Last Name:DRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PNP-AC/PC
Mailing Address - Street 1:225 E CHICAGO AVE # 246
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-1600
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.369047163W00000X
IL209.017632363LP0200X, 363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics