Healthcare Provider Details

I. General information

NPI: 1649829623
Provider Name (Legal Business Name): DELICIA ELNORA ELAINE HOLIDAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
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:
Mailing address:
  • Phone: 312-633-4977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041383646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: