Basic Information
| Provider Information | |||||||||
| NPI: | 1922249895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHATHAM | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | KEAN | ||||||||
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| Credential: | ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 E MASON ST | ||||||||
| Address2: | PRAIRIE HEART INSTITUTE | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627011034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177880706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 E MASON ST | ||||||||
| Address2: | PRAIRIE HEART INSTITUTE | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627011034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177880706 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2009 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | 209.007526041.239054 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 363LA2200X | 209007563 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 207RI0011X | 209-007563 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | P01676614 | 01 | IL | RAILROAD | OTHER |