Healthcare Provider Details
I. General information
NPI: 1386511517
Provider Name (Legal Business Name): DEIARA LASHAE KIZER RN-BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
107 W 74TH ST UNIT G
CHICAGO IL
60621-3403
US
IV. Provider business mailing address
107 W 74TH ST UNIT 2 UNIT G
CHICAGO IL
60621-3403
US
V. Phone/Fax
- Phone: 630-881-7583
- Fax:
- Phone: 630-881-7583
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | 041484642 |
| License Number State | IL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH1000X |
| Taxonomy | Hospice Registered Nurse |
| License Number | 0410484642 |
| License Number State | IL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN1003X |
| Taxonomy | Nutrition Support Registered Nurse |
| License Number | 041484642 |
| License Number State | IL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WS0200X |
| Taxonomy | School Registered Nurse |
| License Number | 041484642 |
| License Number State | IL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0101X |
| Taxonomy | Ambulatory Women's Health Care Registered Nurse |
| License Number | 041484642 |
| License Number State | IL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1744R1103X |
| Taxonomy | Research Study Abstracter/Coder |
| License Number | 0410484642 |
| License Number State | IL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | 0410484642 |
| License Number State | IL |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174H00000X |
| Taxonomy | Health Educator |
| License Number | 0410484642 |
| License Number State | IL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 172V00000X |
| Taxonomy | Community Health Worker |
| License Number | 0410484642 |
| License Number State | IL |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1744R1102X |
| Taxonomy | Research Study Specialist |
| License Number | 0410484642 |
| License Number State | IL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251E00000X |
| Taxonomy | Home Health Agency |
| License Number | 0410484642 |
| License Number State | IL |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251G00000X |
| Taxonomy | Community Based Hospice Care Agency |
| License Number | 0410484642 |
| License Number State | IL |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251K00000X |
| Taxonomy | Public Health or Welfare Agency |
| License Number | 0410484642 |
| License Number State | IL |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251S00000X |
| Taxonomy | Community/Behavioral Health Agency |
| License Number | 0410484642 |
| License Number State | IL |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 041484642 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
