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General NPI Number Information
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NPI Number | 1508400383
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Entity Type | Individual
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Provider Name | CHINITA DILLARD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 11826 S HARVARD AVE
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City | CHICAGO
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State | IL
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Zip | 60628-6008
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Country | US
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Telephone | 708-692-8149
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 185
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City | FLOSSMOOR
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State | IL
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Zip | 60422-0185
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Country | US
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Telephone | 708-692-8149
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043.107060
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License Number State | IL
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