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General NPI Number Information
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NPI Number | 1144981473
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Entity Type | Organization
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Legal Business Name | SHAPERZ INC
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Dates
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Enumeration Date | 01/08/2022
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Last Update Date | 01/08/2022
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Provider Practice Location Address
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Address Line | 3754 W 111TH ST UNIT B
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City | CHICAGO
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State | IL
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Zip | 60655-4008
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Country | US
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Telephone | 773-658-5157
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Fax | 708-931-3446
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Provider Business Mailing Address
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Address Line | 9712 S KEELER AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-3407
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Country | US
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Telephone | 773-875-0069
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Fax | 708-931-3446
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYNN ST. VICTOR-LUCKETT
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Credential | APRN
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Telephone | 773-875-0069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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