Healthcare Provider Details

I. General information

NPI: 1932347663
Provider Name (Legal Business Name): EUNICE D SALLEY CNA AND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 S DAUPHIN AVE SUITE 2
CHICAGO IL
60619-7723
US

IV. Provider business mailing address

9220 S DAUPHIN AVE SUITE 2
CHICAGO IL
60619-7723
US

V. Phone/Fax

Practice location:
  • Phone: 312-576-7127
  • Fax: 773-874-0131
Mailing address:
  • Phone: 312-576-7127
  • Fax: 773-874-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberA
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: