Healthcare Provider Details

I. General information

NPI: 1700048402
Provider Name (Legal Business Name): TANYA JEANNINE WEST-HUTCHINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 S WESTERN AVE STE 700
EVERGREEN PARK IL
60805-2814
US

IV. Provider business mailing address

601 GATEWAY BLVD N
CHESTERTON IN
46304-9658
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-1907
  • Fax: 708-422-4358
Mailing address:
  • Phone: 219-921-1444
  • Fax: 219-921-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28110088A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002691A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: