Provider Demographics
NPI:1790106474
Name:FLANAGAN, AMY (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SOUTH WACKER
Mailing Address - Street 2:SUITE 2155
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:312-627-1300
Mailing Address - Fax:
Practice Address - Street 1:125 S WACKER DR
Practice Address - Street 2:SUITE 2155
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-4424
Practice Address - Country:US
Practice Address - Phone:312-627-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041344664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse