Provider Demographics
NPI:1770810194
Name:GREGORY, AMY L (APN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:GREGORY
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 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE 723
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-883-0723
Mailing Address - Fax:773-883-0724
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 723
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-883-0723
Practice Address - Fax:773-883-0724
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily