Provider Demographics
NPI:1285414201
Name:GAY, CASSANDRA (APRN, AGNP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:APRN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6439 N SHERIDAN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5364
Mailing Address - Country:US
Mailing Address - Phone:773-508-2530
Mailing Address - Fax:773-508-2242
Practice Address - Street 1:808 S WOOD ST # 863W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7300
Practice Address - Country:US
Practice Address - Phone:312-996-0664
Practice Address - Fax:312-413-9123
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028740363LP2300X
IL041295449163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care