MEDICARE: KATRICE WASHINGTON

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	3747P1801X	Personal Care Attendant
2	164W00000X	Licensed Practical Nurse	043102998	IL

General Provider Information

NPI Number	:	1366027716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRICE WASHINGTON

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	HINES
State	:	IL
Zip	:	60141-0424
Country	:	US
Telephone Number	:	773-799-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	7510 S WINCHESTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-5220
Country	:	US
Telephone Number	:	773-799-1808
Fax Number	:

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

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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Directions to “ KATRICE WASHINGTON ” Practice Location

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