Basic Information
| Provider Information | |||||||||
| NPI: | 1013377597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TSSARIO | ||||||||
| FirstName: | CAITLIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 E HURON ST | ||||||||
| Address2: | FEINBERG 5-704 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950061 | ||||||||
| FaxNumber: | 3126955873 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 E HURON ST | ||||||||
| Address2: | FEINBERG 5-704 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950061 | ||||||||
| FaxNumber: | 3126955873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 413524 | OH | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN615940 | PA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 041.442137 | IL | N | Nursing Service Providers | Registered Nurse | 367500000X | 209.014571 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.