MEDICARE: TONEISHA JANA HENDRICKS

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	:	1346182649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONEISHA JANA HENDRICKS

Provider Business Mailing Address
First Line	:	1623 E 68TH ST APT 2B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-7215
Country	:	US
Telephone Number	:	708-275-0078
Fax Number	:	708-275-0087

Provider Business Practice Location Address
First Line	:	1623 E 68TH ST APT 2B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-7215
Country	:	US
Telephone Number	:	708-275-0078
Fax Number	:	708-275-0078

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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