Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Oct 6, 2016
License(s)
2006019267 (MO), F06190182 (MO)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 3001 GREEN BAY RD | North Chicago, IL 60064-3048 | 760-845-0079 |
| MAILING | 3001 GREEN BAY RD | North Chicago, IL 60064-3048 | 224-610-7776 |
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