Provider Demographics
NPI:1114374139
Name:CALDWELL, TESHICA (NP)
Entity type:Individual
Prefix:
First Name:TESHICA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12214 S ADA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5406
Mailing Address - Country:US
Mailing Address - Phone:773-550-7795
Mailing Address - Fax:872-259-5307
Practice Address - Street 1:3344 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3528
Practice Address - Country:US
Practice Address - Phone:773-831-1690
Practice Address - Fax:773-831-1691
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041.351335363LF0000X
IL277.001411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily