Provider Demographics
NPI:1851320568
Name:FAIRCLOTH, ISABEL F (APN,-CCNS , CNP)
Entity Type:Individual
Prefix:MR
First Name:ISABEL
Middle Name:F
Last Name:FAIRCLOTH
Suffix:
Gender:F
Credentials:APN,-CCNS , CNP
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Mailing Address - Street 1:777 N MICHIGAN AVE
Mailing Address - Street 2:APT. 1501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2617
Mailing Address - Country:US
Mailing Address - Phone:312-337-0009
Mailing Address - Fax:312-663-3192
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-4600
Practice Address - Fax:312-864-9569
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health