Provider Demographics
NPI:1609664465
Name:HAYWOOD, TJUANA
Entity type:Individual
Prefix:
First Name:TJUANA
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 S CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2926
Mailing Address - Country:US
Mailing Address - Phone:773-251-0624
Mailing Address - Fax:773-251-0624
Practice Address - Street 1:7725 S CALUMET AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2926
Practice Address - Country:US
Practice Address - Phone:773-251-0624
Practice Address - Fax:773-251-0624
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041424557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse