Healthcare Provider Details

I. General information

NPI: 1093353385
Provider Name (Legal Business Name): MONICA ANGELINA BATCHELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9718 S HALSTED ST
CHICAGO IL
60628-1007
US

IV. Provider business mailing address

1649 BURR OAK RD
HOMEWOOD IL
60430-1808
US

V. Phone/Fax

Practice location:
  • Phone: 773-298-2056
  • Fax:
Mailing address:
  • Phone: 630-246-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209020450
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: