Provider Demographics
NPI:1942328208
Name:SEALS, JUDY GAINEY (NP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:GAINEY
Last Name:SEALS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S MERRILL AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1610
Mailing Address - Country:US
Mailing Address - Phone:773-684-8027
Mailing Address - Fax:773-684-8027
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:12TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2000
Practice Address - Fax:312-328-7739
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ34606Medicare UPIN
ILK45873Medicare PIN
K14295Medicare ID - Type Unspecified
ILK45874Medicare PIN