Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Primary Care
Enumerated
Sep 9, 2015
License(s)
209013110 (IL), 1568830404 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 3001 GREEN BAY RD | North Chicago, IL 60064-3048 | 847-688-6755 |
| MAILING | 9332 LANDINGS LN UNIT 207 | Des Plaines, IL 60016-5257 |
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