Healthcare Provider Details

I. General information

NPI: 1154847093
Provider Name (Legal Business Name): GRETCHEN O TURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4938 N DRAKE AVE
CHICAGO IL
60625-5616
US

IV. Provider business mailing address

4938 N DRAKE AVE
CHICAGO IL
60625-5616
US

V. Phone/Fax

Practice location:
  • Phone: 773-759-3735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: