Provider Demographics
NPI:1568089928
Name:COVINGTON, RAEGINA NMI
Entity Type:Individual
Prefix:
First Name:RAEGINA
Middle Name:NMI
Last Name:COVINGTON
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 1:5329 N GLENWOOD AVE # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2218
Mailing Address - Country:US
Mailing Address - Phone:614-530-3360
Mailing Address - Fax:
Practice Address - Street 1:5329 N GLENWOOD AVE # 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2218
Practice Address - Country:US
Practice Address - Phone:614-530-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.479820163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse