Healthcare Provider Details

I. General information

NPI: 1164880498
Provider Name (Legal Business Name): ROSALIND SEALS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3857 W WASHINGTON BLVD
CHICAGO IL
60624-2342
US

IV. Provider business mailing address

6222 S PULASKI RD STE 3
CHICAGO IL
60629-4610
US

V. Phone/Fax

Practice location:
  • Phone: 773-533-1417
  • Fax: 773-533-7348
Mailing address:
  • Phone: 773-581-8080
  • Fax: 773-581-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: