Provider Demographics
NPI:1821368630
Name:MAHONEY, ERIN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:BUILDING 111
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-327-5864
Mailing Address - Fax:708-327-2424
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:BUILDING 111
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-327-5864
Practice Address - Fax:708-327-2424
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009167363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health