Basic Information
| Provider Information | |||||||||
| NPI: | 1629565007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIDDENS | ||||||||
| FirstName: | MAGGIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 CHICAGO RD | ||||||||
| Address2: | |||||||||
| City: | STEGER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604751055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083006692 | ||||||||
| FaxNumber: | 7087563065 | ||||||||
| Practice Location | |||||||||
| Address1: | 4318 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606093701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732859304 | ||||||||
| FaxNumber: | 7735643501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2018 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209016970 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2017024054 | 01 | IL | BOARD CERTIFICATION | OTHER |