Healthcare Provider Details

I. General information

NPI: 1245162098
Provider Name (Legal Business Name): SANDRA KAY KUCHMA CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 N LINCOLN AVE
CHICAGO IL
60625-2030
US

IV. Provider business mailing address

5045 N KEELER AVE
CHICAGO IL
60630-2715
US

V. Phone/Fax

Practice location:
  • Phone: 630-853-3741
  • Fax:
Mailing address:
  • Phone: 630-853-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: