1326135666 NPI number — MRS. DANA L BEATTY CNM CERTIFIED NURSE

Table of content: MRS. DANA L BEATTY CNM CERTIFIED NURSE (NPI 1326135666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326135666 NPI number — MRS. DANA L BEATTY CNM CERTIFIED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEATTY
Provider First Name:
DANA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM CERTIFIED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAY
Provider Other First Name:
DANA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1326135666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16801 ELLIS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HOLLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-616-8929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 EAST 51ST STREET
Provider Second Line Business Practice Location Address:
PROVIDENT HOSPITAL OF COOK COUNTY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-572-1200
Provider Business Practice Location Address Fax Number:
312-572-1294
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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