Healthcare Provider Details

I. General information

NPI: 1174163034
Provider Name (Legal Business Name): HARRIETT ADELE CAIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N ASHLAND AVE
CHICAGO IL
60607-1802
US

IV. Provider business mailing address

140 N ASHLAND AVE
CHICAGO IL
60607-1802
US

V. Phone/Fax

Practice location:
  • Phone: 312-633-4977
  • Fax: 312-850-9095
Mailing address:
  • Phone: 312-633-4977
  • Fax: 312-850-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number041134434
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: