MEDICARE: PATRICIA CLAY R.N.

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	133NN1002X	Nutrition Education Nutritionist	041396274	IL
2	163W00000X	Registered Nurse	041396274	IL

General Provider Information

NPI Number	:	1790067353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA CLAY R.N.

Provider Business Mailing Address
First Line	:	6511 S BELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-2529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6511 S BELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-2529
Country	:	US
Telephone Number	:	773-960-0948
Fax Number	:

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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