Individual ProviderSamantha Joy EtscheidRegistered NurseNursing Service ProvidersPractice Address4423 N Ravenswood Ave, Chicago, IL 60640-5802(773) 572-5400(630) 780-0499PECOS EnrollmentBased on the most recent information from CMS, provider Samantha Joy Etscheid 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 ID1194305391Provider TypeIndividualFull NameEtscheid, Samantha JoyCredentialRNGenderFemaleSole ProprietorNoEnumeration Date4/12/2021Last Updated4/12/2021Contact InformationPractice LocationPractice Address4423 N Ravenswood Ave, Chicago, IL 60640-5802Phone(773) 572-5400FaxUnlisted FaxMailing LocationMailing Address545 N Dearborn St Apt 3110, Chicago, IL 60654-4464Phone(630) 780-0499FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense041.501616Illinois