Provider Demographics
NPI:1679544977
Name:CHESS, CATHY JEANNE (RN, CPNP)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:JEANNE
Last Name:CHESS
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:811 W 15TH PL
Mailing Address - Street 2:# 506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1505
Mailing Address - Country:US
Mailing Address - Phone:312-513-2634
Mailing Address - Fax:219-836-0527
Practice Address - Street 1:8224 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1704
Practice Address - Country:US
Practice Address - Phone:312-513-2634
Practice Address - Fax:219-836-0527
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO071032363LP0200X
IL209007223363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2679544977Medicaid