Provider Demographics
NPI:1740210004
Name:MACLEAN, CHRISTINE (NPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S PRAIRIE AVE APT 703
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3646
Mailing Address - Country:US
Mailing Address - Phone:155-047-1516
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 117
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3848
Practice Address - Country:US
Practice Address - Phone:312-942-6296
Practice Address - Fax:312-563-2201
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11756363LF0000X
IL209.016382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily