Provider Demographics
NPI:1962144345
Name:BARTH, CASSIDY (RN)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:BARTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6478 N OLYMPIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1519
Mailing Address - Country:US
Mailing Address - Phone:872-333-0384
Mailing Address - Fax:
Practice Address - Street 1:900 SKOKIE BLVD STE 212
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4031
Practice Address - Country:US
Practice Address - Phone:847-272-5882
Practice Address - Fax:847-808-6134
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041511922163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice