Healthcare Provider Details

I. General information

NPI: 1053137943
Provider Name (Legal Business Name): FATUMA KIWALA CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11713 WOODCREEK S APT E
HUNTLEY IL
60142-7350
US

IV. Provider business mailing address

11713 WOODCREEK S APT E
HUNTLEY IL
60142-7350
US

V. Phone/Fax

Practice location:
  • Phone: 331-230-1154
  • Fax:
Mailing address:
  • Phone: 331-230-1154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberK40024093749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: