Provider Demographics
NPI:1942945332
Name:HAYATO UNSETH, CRISTIANE
Entity Type:Individual
Prefix:
First Name:CRISTIANE
Middle Name:
Last Name:HAYATO UNSETH
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 1:1270 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3728
Mailing Address - Country:US
Mailing Address - Phone:847-881-5777
Mailing Address - Fax:
Practice Address - Street 1:1270 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3728
Practice Address - Country:US
Practice Address - Phone:847-881-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant