Healthcare Provider Details

I. General information

NPI: 1760593503
Provider Name (Legal Business Name): BENEDICTA E RAMOS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON SUITE 408 WEST
CHICAGO IL
60612
US

IV. Provider business mailing address

1325 N MONITOR AVENUE
CHICAGO IL
60651
US

V. Phone/Fax

Practice location:
  • Phone: 312-997-2229
  • Fax: 312-666-4163
Mailing address:
  • Phone: 773-378-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: