Individual provider Active NPI

Cathleen Ann Nick, DDS

  • Dentist
  • Chicago, IL
National Provider Identifier
1770078958
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
N387207 Issued in MI
Practice address
2334 W Lawrence Ave Ste 201
Chicago, IL 60625-1046
Phone
(773) 458-4078
NPI assigned
Jun 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X N387207 MI Primary

Addresses

Primary practice location

2334 W Lawrence Ave Ste 201
Chicago, IL 60625-1046

Mailing address

6336 N Knox Ave
Chicago, IL 60646-4412
Phone (773) 458-4078

Other practice location 1

1469 S 70th St
West Allis, WI 53214-4814
Phone (773) 458-4078

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
N387207MIMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1770078958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6336 N KNOX AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606464412",
            "telephone_number": "773-458-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2334 W LAWRENCE AVE STE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606251046",
            "telephone_number": "773-458-4078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1469 S 70th St",
            "address_purpose": "LOCATION",
            "city": "West Allis",
            "state": "WI",
            "postal_code": "532144814",
            "country_code": "US",
            "telephone_number": "773-458-4078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICK",
        "first_name": "CATHLEEN",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "N387207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.