Healthcare Provider Details

I. General information

NPI: 1639520018
Provider Name (Legal Business Name): MS. VIVIAN ESEOGHENE DENIRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 RAND RD
DES PLAINES IL
60016-3509
US

IV. Provider business mailing address

1717 RAND RD
DES PLAINES IL
60016-3509
US

V. Phone/Fax

Practice location:
  • Phone: 847-376-2112
  • Fax: 847-390-8214
Mailing address:
  • Phone: 847-376-2112
  • Fax: 847-390-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: