Provider Demographics
NPI:1790235398
Name:PHELPS, CLARE (APN)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E HURON ST STE 11-140
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2968
Mailing Address - Country:US
Mailing Address - Phone:312-926-1711
Mailing Address - Fax:312-926-4870
Practice Address - Street 1:201 E HURON ST STE 11-140
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2968
Practice Address - Country:US
Practice Address - Phone:312-926-1711
Practice Address - Fax:312-926-4870
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014930 041.3776363LA2100X
IL209014930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care