Healthcare Provider Details

I. General information

NPI: 1861813784
Provider Name (Legal Business Name): CHAKINA BRUNSON APN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 S PROMONTORY DR
CHICAGO IL
60649-1003
US

IV. Provider business mailing address

6142 S WOODLAWN AVE 3N
CHICAGO IL
60637-2865
US

V. Phone/Fax

Practice location:
  • Phone: 773-256-5746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041356343
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209011327
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: