Provider Demographics
NPI:1669465480
Name:MCCAFFERTY, MAUREEN A (RN, APN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2504
Mailing Address - Country:US
Mailing Address - Phone:708-576-8150
Mailing Address - Fax:708-576-8831
Practice Address - Street 1:4950 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2504
Practice Address - Country:US
Practice Address - Phone:708-576-8150
Practice Address - Fax:708-576-8831
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-204506163W00000X
IL209-004103364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL526200OtherMEDICARE GROUP #
IL21622931OtherBCBS GROUP #
ILCI8250OtherPALMETTO GBA GROUP #
ILP00051231OtherPALMETTO GBA INDIVIDUAL #
IL041204506Medicaid
ILCI8250OtherPALMETTO GBA GROUP #
IL21622931OtherBCBS GROUP #
ILP79295Medicare UPIN