Healthcare Provider Details

I. General information

NPI: 1659040780
Provider Name (Legal Business Name): RASHAWNDA MCCORNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 09/11/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 S WABASH AVE
CHICAGO IL
60628-3532
US

IV. Provider business mailing address

10931 S WABASH AVE
CHICAGO IL
60628-3532
US

V. Phone/Fax

Practice location:
  • Phone: 773-503-3501
  • Fax:
Mailing address:
  • Phone: 773-503-3501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: