Healthcare Provider Details

I. General information

NPI: 1083542369
Provider Name (Legal Business Name): LATRICE DANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 S MAPEWOOD AVE
CHICAGO IL
60612
US

IV. Provider business mailing address

343 S MAPLEWOOD AVE
CHICAGO IL
60612-2883
US

V. Phone/Fax

Practice location:
  • Phone: 773-653-6287
  • Fax:
Mailing address:
  • Phone: 773-653-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: