Healthcare Provider Details

I. General information

NPI: 1154678019
Provider Name (Legal Business Name): KEESHA MONIQUE RIMMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EAST 33RD ST. APT. 1100
CHICAGO IL
60616-4242
US

IV. Provider business mailing address

500 E 33RD ST APT 1100
CHICAGO IL
60616-4242
US

V. Phone/Fax

Practice location:
  • Phone: 773-288-9515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number041401989
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: