Basic Information
| Provider Information | |||||||||
| NPI: | 1881927457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NILSSON | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.N, A.P.N-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 W 95TH ST | ||||||||
| Address2: | SUITE 407-409 | ||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604532654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776844327 | ||||||||
| FaxNumber: | 7086847040 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 W 95TH ST | ||||||||
| Address2: | SUITE 407-409 | ||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604532654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776844327 | ||||||||
| FaxNumber: | 7086847040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2009 | ||||||||
| LastUpdateDate: | 03/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | 209.007591 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.