Healthcare Provider Details

I. General information

NPI: 1427314707
Provider Name (Legal Business Name): CLAUDIA D. AUSTIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 W. CHICAGO AVE. COMMUMITY HEALTH CLINIC
CHICAGO IL
60622
US

IV. Provider business mailing address

2611 W. CHICAGO AVE. COMMUMITY HEALTH CLINIC
CHICAGO IL
60622
US

V. Phone/Fax

Practice location:
  • Phone: 773-395-9900
  • Fax:
Mailing address:
  • Phone: 773-395-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209001605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: