Provider Demographics
NPI:1922249895
Name:CHATHAM, NANCY KEAN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KEAN
Last Name:CHATHAM
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 1:619 E MASON ST
Mailing Address - Street 2:PRAIRIE HEART INSTITUTE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1034
Mailing Address - Country:US
Mailing Address - Phone:217-788-0706
Mailing Address - Fax:
Practice Address - Street 1:619 E MASON ST
Practice Address - Street 2:PRAIRIE HEART INSTITUTE
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1034
Practice Address - Country:US
Practice Address - Phone:217-788-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007526041.239054364S00000X
IL209007563363LA2200X
IL209-007563207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01676614OtherRAILROAD
ILP01676614OtherRAILROAD
IL$$$$$$$$$001Medicaid