Provider Demographics
NPI:1740749324
Name:BAIZA, CARINA VIRGINIA (RN)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:VIRGINIA
Last Name:BAIZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 FERNDALE ST
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2832
Mailing Address - Country:US
Mailing Address - Phone:224-944-3460
Mailing Address - Fax:
Practice Address - Street 1:2216 20TH ST
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-1648
Practice Address - Country:US
Practice Address - Phone:224-944-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041454799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse