Healthcare Provider Details

I. General information

NPI: 1043677529
Provider Name (Legal Business Name): TAMMY CHAVARRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TRANSAM PLAZA DR STE 400
OAKBROOK TERRACE IL
60181-4808
US

IV. Provider business mailing address

2 TRANSAM PLAZA DR STE 400
OAKBROOK TERRACE IL
60181-4808
US

V. Phone/Fax

Practice location:
  • Phone: 630-545-3766
  • Fax: 630-933-7392
Mailing address:
  • Phone: 630-545-3766
  • Fax: 630-933-7392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209005920
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71002390A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209005920
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number041303804
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number28172884A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: