1578657862 NPI number — MS. RENEAU ALBERTA DIALLO CNM APN

Table of content: MS. RENEAU ALBERTA DIALLO CNM APN (NPI 1578657862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578657862 NPI number — MS. RENEAU ALBERTA DIALLO CNM APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIALLO
Provider First Name:
RENEAU
Provider Middle Name:
ALBERTA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUCKNER
Provider Other First Name:
RENEAU
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578657862
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:
9010 S EUCLID
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-721-7193
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:
10/03/2006

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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