Individual
MISS KAWANA FANTASIA THARPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, APRN, FNP-C
Contact information
Practice address
4747 N KEDZIE AVE, CHICAGO, IL 60625-4420
(312) 666-3494
Mailing address
4747 N KEDZIE AVE, CHICAGO, IL 60625-4420
(312) 666-3494
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
041436212
IL
363LF0000X
Family Nurse Practitioner
Primary
209024591
IL
Other
Enumeration date
07/09/2020
Last updated
08/23/2022
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