Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Nov 9, 2020
License(s)
209.022385 (IL), 209.022385 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1337 W FARGO AVE APT 401 | Chicago, IL 60626-1854 | 773-431-2992 |
| MAILING | 1337 W FARGO AVE APT 401 | Chicago, IL 60626-1854 | 773-431-2992 |
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