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NPI Code Detail

MEDICARE: MS. TAMIKA C BERKLEY FNP

MEDICARE: MS. TAMIKA C BERKLEY FNP
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
1363L00000XNurse Practitioner209.008639IL

General Provider Information

NPI Number : 1528365491
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMIKA C BERKLEY FNP
Provider Business Mailing Address
First Line : 175 N KENILWORTH AVE
Second Line : APT 2C
City : OAK PARK
State : IL
Zip : 60301-1272
Country : US
Telephone Number : 708-763-3116
Fax Number :
Provider Business Practice Location Address
First Line : 2656 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2019
Country : US
Telephone Number : 773-252-1994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2011
Last Update Date : 02/11/2011

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