Provider Demographics
NPI:1801373337
Name:MUHAMMAD, DALE (RN)
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:
Last Name:MUHAMMAD
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 1:20901 CORINTH RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1872
Mailing Address - Country:US
Mailing Address - Phone:773-573-9843
Mailing Address - Fax:
Practice Address - Street 1:2024 HICKORY RD STE 306
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2145
Practice Address - Country:US
Practice Address - Phone:773-573-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000553163WP0200X, 164W00000X, 376K00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide