Provider Demographics
NPI:1003250358
Name:PREEDIN, NAOMI ROSE
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:ROSE
Last Name:PREEDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1526
Mailing Address - Country:US
Mailing Address - Phone:708-217-0561
Mailing Address - Fax:
Practice Address - Street 1:3825 MORTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1526
Practice Address - Country:US
Practice Address - Phone:708-217-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program