Healthcare Provider Details

I. General information

NPI: 1669646030
Provider Name (Legal Business Name): MS. ZABRINA L WORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 S SAWYER AVE
CHICAGO IL
60629-3537
US

IV. Provider business mailing address

7205 S SAWYER AVE
CHICAGO IL
60629-3537
US

V. Phone/Fax

Practice location:
  • Phone: 773-590-6783
  • Fax:
Mailing address:
  • Phone: 773-590-6783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number4122239396062901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: