Provider Demographics
NPI:1700661436
Name:HATCHETT, TARSHA
Entity Type:Individual
Prefix:
First Name:TARSHA
Middle Name:
Last Name:HATCHETT
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 1:7061 NORTH AVE # 117
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1015
Mailing Address - Country:US
Mailing Address - Phone:773-844-5757
Mailing Address - Fax:
Practice Address - Street 1:4223 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-1723
Practice Address - Country:US
Practice Address - Phone:773-844-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041407140163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse