Healthcare Provider Details

I. General information

NPI: 1255739165
Provider Name (Legal Business Name): HELEN MUJICA CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 24TH ST
NORTH CHICAGO IL
60064-3128
US

IV. Provider business mailing address

2006 24TH ST
NORTH CHICAGO IL
60064-3128
US

V. Phone/Fax

Practice location:
  • Phone: 224-302-2727
  • Fax:
Mailing address:
  • Phone: 224-302-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: