Provider Demographics
NPI:1477933034
Name:KING, DENISE E (MSN, RN-BC, CCM)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:MSN, RN-BC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 N NORMANDY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2105
Mailing Address - Country:US
Mailing Address - Phone:773-806-9056
Mailing Address - Fax:
Practice Address - Street 1:6218 N NORMANDY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2105
Practice Address - Country:US
Practice Address - Phone:773-806-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15570030163W00000X
IL00130579163WC0400X
IL041245195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management