Healthcare Provider Details

I. General information

NPI: 1174787394
Provider Name (Legal Business Name): NENITA P CUDIAMAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 WARWICK DR
CAROL STREAM IL
60188-4332
US

IV. Provider business mailing address

668 WARWICK DR
CAROL STREAM IL
60188-4332
US

V. Phone/Fax

Practice location:
  • Phone: 630-483-8756
  • Fax:
Mailing address:
  • Phone: 630-483-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number041209196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: