Provider Demographics
NPI:1962625756
Name:AZTLAN-KEAHEY, EVELYN ANGEL (NP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ANGEL
Last Name:AZTLAN-KEAHEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:ANGEL
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:659 W. WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661
Mailing Address - Country:US
Mailing Address - Phone:312-707-8988
Mailing Address - Fax:312-707-9223
Practice Address - Street 1:659 W. WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661
Practice Address - Country:US
Practice Address - Phone:312-707-8988
Practice Address - Fax:312-707-9223
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16838363LW0102X
IL209-012888367A00000X
IL209-012889363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife