MEDICARE: TIARA LASHAY BRAZILL-JONES

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	163WC1500X	Community Health Registered Nurse	041545418	IL

General Provider Information

NPI Number	:	1407663180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIARA LASHAY BRAZILL-JONES

Provider Business Mailing Address
First Line	:	6041 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6041 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4395
Country	:	US
Telephone Number	:	773-388-1600
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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