Healthcare Provider Details

I. General information

NPI: 1194008425
Provider Name (Legal Business Name): KENYATTA EVANS-SNULLIGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENYATTA EVANS NP

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W CERMAK RD CUITE C119
CHICAGO IL
60608-4500
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-2223
  • Fax: 312-243-2227
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number041361698
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209-008944
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: