Healthcare Provider Details

I. General information

NPI: 1982526158
Provider Name (Legal Business Name): RENEE DAVENPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 S INDIANA AVE APT 2
CHICAGO IL
60653-5148
US

IV. Provider business mailing address

4327 S INDIANA AVE APT 2
CHICAGO IL
60653-5148
US

V. Phone/Fax

Practice location:
  • Phone: 773-266-6222
  • Fax:
Mailing address:
  • Phone: 773-266-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041442399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: