Healthcare Provider Details

I. General information

NPI: 1740627058
Provider Name (Legal Business Name): ANTRELENE WARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ANTRELENE WARD

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14439 S. DANTE
DOLTON IL
60419-1907
US

IV. Provider business mailing address

14439 DANTE AVE
DOLTON IL
60419-1911
US

V. Phone/Fax

Practice location:
  • Phone: 708-655-5972
  • Fax:
Mailing address:
  • Phone: 708-655-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number041370735
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041370735
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: