Healthcare Provider Details

I. General information

NPI: 1942173810
Provider Name (Legal Business Name): LATANJIA DENISE PRYOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 900
CHICAGO IL
60611-2977
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 900
CHICAGO IL
60611-2977
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3155
  • Fax: 312-926-1787
Mailing address:
  • Phone: 312-926-3155
  • Fax: 312-926-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041335096
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: