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General NPI Number Information
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NPI Number | 1366955940
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Entity Type | Individual
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Provider Name | DEBRA CHANA GOLDSTEIN RN, CPNP, CLS
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Gender | Female
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 2732 W CHASE AVE
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City | CHICAGO
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State | IL
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Zip | 60645-1313
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Country | US
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Telephone | 773-743-6133
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Fax | 773-743-6133
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Provider Business Mailing Address
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Address Line | 2732 W CHASE AVE
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City | CHICAGO
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State | IL
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Zip | 60645-1313
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Country | US
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Telephone | 773-743-6133
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209.016244
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License Number State | IL
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