Healthcare Provider Details

I. General information

NPI: 1043774763
Provider Name (Legal Business Name): RASHIDAH ABDULLAH CNM, RN, CBC, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N LARAMIE AVE
CHICAGO IL
60651-1407
US

IV. Provider business mailing address

1536 N LARAMIE AVE
CHICAGO IL
60651-1407
US

V. Phone/Fax

Practice location:
  • Phone: 708-359-9951
  • Fax:
Mailing address:
  • Phone: 708-359-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041259265
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number554007243
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041259265
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209001301
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: