Provider Demographics
NPI:1447033055
Name:GRACEY, RENEE SHEREE (FNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:SHEREE
Last Name:GRACEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E SUPERIOR ST STE 4-420
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-472-0420
Mailing Address - Fax:312-926-6363
Practice Address - Street 1:250 E SUPERIOR ST STE 4-420
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-0420
Practice Address - Fax:312-926-6363
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027099363LF0000X
IL209027099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily