Individual
UTA J TICHAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APN-BC, ANP
Contact information
Practice address
1426 W IRVING PARK RD, CHICAGO, IL 60613-5698
(773) 925-4700
Mailing address
1426 W IRVING PARK RD, CHICAGO, IL 60613-5698
(773) 925-4700
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209.007356
IL
Other
Enumeration date
12/10/2008
Last updated
12/10/2008
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