Healthcare Provider Details

I. General information

NPI: 1295618916
Provider Name (Legal Business Name): PRACTITIONER2YOULLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 N WOOD DALE RD
WOOD DALE IL
60191-1578
US

IV. Provider business mailing address

343 N WOOD DALE RD
WOOD DALE IL
60191-1578
US

V. Phone/Fax

Practice location:
  • Phone: 773-299-9299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARYRSHA DAVIS
Title or Position: NURSE PRACTITIONER
Credential: DR
Phone: 312-636-3722