Basic Information
| Provider Information | |||||||||
| NPI: | 1316242423 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANKO | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 E ONTARIO ST | ||||||||
| Address2: | APT# 4205B | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493221709 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2355 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606083837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732541400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2011 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041.393906 | IL | N | Nursing Service Providers | Registered Nurse | 163W00000X | 616314-1 | NY | N | Nursing Service Providers | Registered Nurse | 367A00000X | 209.008916 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | F001417-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.