Provider Demographics
NPI:1821233446
Name:TICHAWA, UTA J (RN, APN-BC, ANP)
Entity Type:Individual
Prefix:
First Name:UTA
Middle Name:J
Last Name:TICHAWA
Suffix:
Gender:F
Credentials:RN, APN-BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5698
Mailing Address - Country:US
Mailing Address - Phone:773-925-4700
Mailing Address - Fax:
Practice Address - Street 1:1426 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5698
Practice Address - Country:US
Practice Address - Phone:773-925-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007356363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health