Taura Bronson
Individual provider Active NPI Driver · Lynwood, IL
NPI 1770959397 · NPPES record last updated Aug 18, 2015
Key facts
- NPI
- 1770959397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 20146 Arroyo Ave
Lynwood, IL 60411-1563 - Phone
- (773) 851-2311
- NPI assigned
- Aug 18, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | IL | Yes |
Addresses
Primary practice location
20146 Arroyo Ave
Lynwood, IL 60411-1563
Mailing address
20146 Arroyo Ave
Lynwood, IL 60411-1563
Phone (773) 851-2311
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000000 | Medicaid | IL |
Other providers in Lynwood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.