Provider Demographics
NPI:1528593415
Name:BELL, CONSWAYLLA JEAN
Entity Type:Individual
Prefix:
First Name:CONSWAYLLA
Middle Name:JEAN
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONSWAYLLA
Other - Middle Name:JEAN
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:8730 S ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1125
Mailing Address - Country:US
Mailing Address - Phone:773-824-5270
Mailing Address - Fax:
Practice Address - Street 1:8730 S ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1125
Practice Address - Country:US
Practice Address - Phone:773-824-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.441253163W00000X
IN28228296A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse