Healthcare Provider Details

I. General information

NPI: 1326135666
Provider Name (Legal Business Name): DANA L BEATTY CNM CERTIFIED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA L GRAY

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EAST 51ST STREET PROVIDENT HOSPITAL OF COOK COUNTY
CHICAGO IL
60615-2400
US

IV. Provider business mailing address

16801 ELLIS AVENUE
SOUTH HOLLAND IL
60473
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-1200
  • Fax: 312-572-1294
Mailing address:
  • Phone: 773-616-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: