Provider Demographics
NPI:1962945261
Name:BALE, BASIRAT ROMOKE (APN, DNP)
Entity type:Individual
Prefix:
First Name:BASIRAT
Middle Name:ROMOKE
Last Name:BALE
Suffix:
Gender:F
Credentials:APN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 S KARLOV AVE
Mailing Address - Street 2:APT. 203
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3389
Mailing Address - Country:US
Mailing Address - Phone:708-299-3064
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:773-834-4946
Practice Address - Fax:773-834-2058
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner