Provider Demographics
NPI:1679052807
Name:LEE, CHIQUITA
Entity Type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:
Last Name:LEE
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 1:9449 S KEDZIE AVE STE 357
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:312-607-1795
Mailing Address - Fax:
Practice Address - Street 1:9449 S KEDZIE AVE STE 357
Practice Address - Street 2:
Practice Address - City:EVERGREEN PK
Practice Address - State:IL
Practice Address - Zip Code:60805-2325
Practice Address - Country:US
Practice Address - Phone:312-607-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041391182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse