Provider Demographics
NPI:1699398024
Name:EPTING, DASHARAY
Entity Type:Individual
Prefix:
First Name:DASHARAY
Middle Name:
Last Name:EPTING
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 1:1115 W GARFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1528
Mailing Address - Country:US
Mailing Address - Phone:515-305-7910
Mailing Address - Fax:
Practice Address - Street 1:1115 W GARFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1528
Practice Address - Country:US
Practice Address - Phone:515-305-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA298837376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85-0921247OtherIRS