Individual
BEVERLY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1443
(888) 824-0200
Mailing address
1800 W ROSCOE ST APT 323, CHICAGO, IL 60657-1012
(847) 899-2234
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041439265
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209031260
IL
Other
Enumeration date
07/18/2023
Last updated
03/20/2025
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