MEDICARE: TRACY WILLIAMS LPN

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	164W00000X	Licensed Practical Nurse	043088407	IL

General Provider Information

NPI Number	:	1811356587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY WILLIAMS LPN

Provider Business Mailing Address
First Line	:	6125 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2818
Country	:	US
Telephone Number	:	773-752-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2818
Country	:	US
Telephone Number	:	773-752-6000
Fax Number	:

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	08/24/2022

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Directions to “ TRACY WILLIAMS LPN” Practice Location

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