Healthcare Provider Details

I. General information

NPI: 1851845622
Provider Name (Legal Business Name): DEASHLON CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 S PULASKI RD
CHICAGO IL
60652-3633
US

IV. Provider business mailing address

8616 S PULASKI RD
CHICAGO IL
60652-3633
US

V. Phone/Fax

Practice location:
  • Phone: 773-838-5030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: