Provider Demographics
NPI:1336592609
Name:WASHINGTON, GERALDINE
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:WASHINGTON
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 1:13613 S CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:IL
Mailing Address - Zip Code:60472-1413
Mailing Address - Country:US
Mailing Address - Phone:708-389-0321
Mailing Address - Fax:708-389-0321
Practice Address - Street 1:13613 S CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:IL
Practice Address - Zip Code:60472-1413
Practice Address - Country:US
Practice Address - Phone:708-389-0321
Practice Address - Fax:708-389-0321
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILW25228061802343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)