Provider Demographics
NPI:1922641513
Name:OLASCOAGA, JANTHINA SUZEL (RN)
Entity Type:Individual
Prefix:
First Name:JANTHINA
Middle Name:SUZEL
Last Name:OLASCOAGA
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 1:3723 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4232
Mailing Address - Country:US
Mailing Address - Phone:773-895-5980
Mailing Address - Fax:
Practice Address - Street 1:3723 W 70TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4232
Practice Address - Country:US
Practice Address - Phone:773-895-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041460320163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health