Healthcare Provider Details

I. General information

NPI: 1831473040
Provider Name (Legal Business Name): RACHEL WANGUI MUTHUI ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W FULTON ST 3RD FLOOR
CHICAGO IL
60612-2345
US

IV. Provider business mailing address

2003 W FULTON ST 3RD FLOOR
CHICAGO IL
60612-2345
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-4800
  • Fax: 312-738-1624
Mailing address:
  • Phone: 773-292-4800
  • Fax: 312-738-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209009114
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: