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General NPI Number Information
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NPI Number | 1043872112
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Entity Type | Individual
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Provider Name | CHENA BAITY BACHELORS, MASTERS,
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Gender | Female
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 629 NORTHGATE LN
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City | SHOREWOOD
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State | IL
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Zip | 60404-9551
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Country | US
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Telephone | 708-316-8724
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Fax | 815-409-7926
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Provider Business Mailing Address
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Address Line | PO BOX 598
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City | PLAINFIELD
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State | IL
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Zip | 60544-0598
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Country | US
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Telephone | 708-316-8724
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Fax | 815-409-7926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043069407
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | IL
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