Individual ProviderSamiyyah EdmistonRegistered NurseNursing Service ProvidersPractice Address1015 W Lawrence Ave Fl 2, Chicago, IL 60640-5017(773) 275-2586PECOS EnrollmentBased on the most recent information from CMS, provider Samiyyah Edmiston does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1053938738Provider TypeIndividualFull NameEdmiston, SamiyyahCredentialRNGenderFemaleSole ProprietorNoEnumeration Date6/29/2020Last Updated6/29/2020Contact InformationPractice LocationPractice Address1015 W Lawrence Ave Fl 2, Chicago, IL 60640-5017Phone(773) 275-2586FaxUnlisted FaxMailing LocationMailing Address1015 W Lawrence Ave Fl 2, Chicago, IL 60640-5017Phone(773) 275-2586FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense041.444621Illinois