Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Jun 12, 2015
License(s)
209011670 (IL), 209011670 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 29373 NETWORK PL | Chicago, IL 60673-1293 | |
| LOCATION | 7501 GRAND AVE | Gurnee, IL 60031-1551 | 800-323-8622 |
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