Healthcare Provider Details

I. General information

NPI: 1295002673
Provider Name (Legal Business Name): EVA VIVIAN-JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 S RICHMOND ST
CHICAGO IL
60652-2735
US

IV. Provider business mailing address

8112 S RICHMOND ST
CHICAGO IL
60652-2735
US

V. Phone/Fax

Practice location:
  • Phone: 773-970-1801
  • Fax: 888-649-4611
Mailing address:
  • Phone: 773-970-1801
  • Fax: 888-649-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number1899264
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: