MEDICARE: MISS MARIA THERESA J HADUCA R.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	163WH0200X	Home Health Registered Nurse		IL

General Provider Information

NPI Number	:	1659584050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA THERESA J HADUCA R.N.

Provider Business Mailing Address
First Line	:	8300 CONCORD DRIVE
Second Line	:	SUITE 310
City	:	MORTON GROVE
State	:	IL
Zip	:	60053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 W HIGGINS AVE
Second Line	:	SUITE C
City	:	CHICAGO
State	:	IL
Zip	:	60656-2009
Country	:	US
Telephone Number	:	773-774-5460
Fax Number	:	773-774-5461

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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