Provider Demographics
NPI:1326797143
Name:TRICE, ABENA ZAKIYAH KUNTO (CD, LC)
Entity Type:Individual
Prefix:
First Name:ABENA
Middle Name:ZAKIYAH KUNTO
Last Name:TRICE
Suffix:
Gender:F
Credentials:CD, LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 W 104TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:773-225-4221
Mailing Address - Fax:
Practice Address - Street 1:1536 W 104TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-225-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula