Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Jan 23, 2019
License(s)
209.018674 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 10830 S HALSTED ST | Chicago, IL 60628-3126 | 773-785-8000 |
| MAILING | PO BOX 3855 | Carol Stream, IL 60132-3855 | 773-785-8000 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.