1043872112 NPI number — MRS. CHENA BAITY BACHELORS, MASTERS,

Table of content: MRS. CHENA BAITY BACHELORS, MASTERS, (NPI 1043872112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043872112 NPI number — MRS. CHENA BAITY BACHELORS, MASTERS,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAITY
Provider First Name:
CHENA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BACHELORS, MASTERS,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURNER
Provider Other First Name:
CHENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CHENA TURNER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043872112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 598
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60544-0598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-316-8724
Provider Business Mailing Address Fax Number:
815-409-7926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
629 NORTHGATE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOREWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60404-9551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-316-8724
Provider Business Practice Location Address Fax Number:
815-409-7926
Provider Enumeration Date:
06/28/2019

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: 164W00000X , with the licence number:  043069407 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , 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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