MEDICARE: TIRANEY REDMOND

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	163W00000X	Registered Nurse	041318088	IL
2	363L00000X	Nurse Practitioner	209019206	IL

General Provider Information

NPI Number	:	1538639406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIRANEY REDMOND

Provider Business Mailing Address
First Line	:	3439 W 82ND PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2503
Country	:	US
Telephone Number	:	773-386-3439
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 SIBLEY BLVD STE 104
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2153
Country	:	US
Telephone Number	:	708-933-0872
Fax Number	:

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

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	07/08/2019

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Directions to “ TIRANEY REDMOND ” Practice Location

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