Provider Demographics
NPI:1427899210
Name:WASHINGTON, KEONNA (BSN, RN)
Entity type:Individual
Prefix:
First Name:KEONNA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 W TAYLOR ST # 2607
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:323-453-6486
Mailing Address - Fax:
Practice Address - Street 1:1440 W TAYLOR ST # 2607
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4623
Practice Address - Country:US
Practice Address - Phone:323-453-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041424582163W00000X, 163WC1600X, 163WI0500X, 163WM1400X, 163WS0121X, 163WW0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No163WW0000XNursing Service ProvidersRegistered NurseWound Care