Provider Demographics
NPI:1962658625
Name:MOHAMMAD, MIRIAM DE OCAMPO (RN)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:DE OCAMPO
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:LATAG
Other - Last Name:DE OCAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:347 DEERING LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6164
Mailing Address - Country:US
Mailing Address - Phone:312-569-6241
Mailing Address - Fax:
Practice Address - Street 1:347 DEERING LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-6164
Practice Address - Country:US
Practice Address - Phone:312-569-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.346313163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse