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NPI Code Detail

MEDICARE: AMY USWAJESDAKUL FNP

MEDICARE: AMY USWAJESDAKUL FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209.010868IL
2363L00000XNurse Practitioner209.010868IL

General Provider Information

NPI Number : 1194154963
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY USWAJESDAKUL FNP
Provider Business Mailing Address
First Line : 1645 W SCHOOL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2157
Country : US
Telephone Number : 773-227-3669
Fax Number :
Provider Business Practice Location Address
First Line : 1645 W SCHOOL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2157
Country : US
Telephone Number : 773-227-3669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2013
Last Update Date : 09/12/2017

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