MEDICARE: HELEN MUJICA CNA

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
1	376K00000X	Nurse's Aide		IL

General Provider Information

NPI Number	:	1255739165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN MUJICA CNA

Provider Business Mailing Address
First Line	:	2006 24TH ST
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-3128
Country	:	US
Telephone Number	:	224-302-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 24TH ST
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-3128
Country	:	US
Telephone Number	:	224-302-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	12/09/2014

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Directions to “ HELEN MUJICA CNA” Practice Location

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