Provider Demographics
NPI:1376007922
Name:UMENZE, DOROTHY E
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:E
Last Name:UMENZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DORATHY
Other - Middle Name:E
Other - Last Name:ARHEBUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4059 S CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2249
Mailing Address - Country:US
Mailing Address - Phone:773-653-5735
Mailing Address - Fax:
Practice Address - Street 1:4059 S CALUMET AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-2249
Practice Address - Country:US
Practice Address - Phone:773-653-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily