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General NPI Number Information
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NPI Number | 1295966562
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Entity Type | Individual
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Provider Name | MRS. CARLA MARIA LENNAN
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Gender | Female
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 6343 S. WESTERN
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City | CHICAGO
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State | IL
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Zip | 60636
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Country | US
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Telephone | 312-719-1811
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Fax | 773-723-7163
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Provider Business Mailing Address
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Address Line | 5230-34 S. BLACKSTONE SUITE A
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City | CHICAGO
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State | IL
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Zip | 60615
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Country | US
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Telephone | 312-719-1811
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Fax | 773-723-7163
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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