Provider Demographics
NPI:1760504716
Name:SCURRY, KAREN LYNETTE (PAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNETTE
Last Name:SCURRY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNETTE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:3860 WEST OGDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623
Mailing Address - Country:US
Mailing Address - Phone:773-843-3000
Mailing Address - Fax:773-843-2704
Practice Address - Street 1:3860 WEST OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-843-3000
Practice Address - Fax:773-843-2704
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085000939OtherSTATE LICENSE
IL385000282OtherCS LICENSE
IL1034924OtherSPECIALTY BOARDS
ILMM0873566OtherDEA