EZIAHA R GEORGEWILL


Address: 17800 Kedzie Ave # A, Hazel Crest, IL 60429-2029
Phone: 7087998000

EZIAHA R GEORGEWILL (NPI# 1013521038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1013521038
Entity Type Individual
Full Name EZIAHA R GEORGEWILL
Credential APRN-BC, C
Practice Address 17800 Kedzie Ave # A
Hazel Crest
IL 60429-2029
Mailing Address 17800 Kedzie Ave
Hazel Crest
IL 60429-2029
Practice Telephone 7087998000
Mailing Telephone 7087998000
Enumeration Date 2020-09-08
Last Update Date 2020-09-08
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP2300X Nurse Practitioner
Specialization: Primary Care
209.021912 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 17800 KEDZIE AVE # A
City HAZEL CREST
State IL
Zip Code 60429-2029

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1710331053 Lauiren Orta Counselor 1901 Cheker Square, E Hazel Crest, IL 60429 2016-04-22
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1770969354 Karriem's Developmental Services Day Training, Developmentally Disabled Services 18513 River Road, Hazel Crest, IL 60429 2015-08-05
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1194066019 Marilyn C Scott Psychologist 18505 Meadow Ln., Hazel Crest, IL 60429 2013-03-04
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Taxonomy Information

Taxonomy Code 363LP2300X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Primary Care

Taxonomy Definition

Definition to come...

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1699315697 Kelsey L Proehl Nurse Practitioner 70 Meadowview Ctr Ste 300, Kankakee, IL 60901-2062 2020-01-08
1992343248 Maryanne M Smith Nurse Practitioner 805 W Deyoung St Ste D, Marion, IL 62959-1602 2019-12-17
1730724451 Suzana None Nikitovic Nurse Practitioner 2815 Regner Rd, Mchenry, IL 60051-6942 2019-11-18
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Competitor

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City HAZEL CREST
Zip Code 60429

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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