MEDICARE: HATTIE WEATHERS L.P.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	43-37444	IL

General Provider Information

NPI Number	:	1306951835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HATTIE WEATHERS L.P.N

Provider Business Mailing Address
First Line	:	625 N MICHIGAN AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3162
Country	:	US
Telephone Number	:	312-670-2530
Fax Number	:	312-670-2630

Provider Business Practice Location Address
First Line	:	625 N MICHIGAN AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3162
Country	:	US
Telephone Number	:	312-670-2530
Fax Number	:	312-670-2630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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