Healthcare Provider Details

I. General information

NPI: 1558272351
Provider Name (Legal Business Name): PRISCA TUYISHIME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 NEWTON AVE
GLEN ELLYN IL
60137-5303
US

IV. Provider business mailing address

2135 W ADAMS ST APT 3
CHICAGO IL
60612-3180
US

V. Phone/Fax

Practice location:
  • Phone: 630-615-0567
  • Fax:
Mailing address:
  • Phone: 630-615-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.113099
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: