Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Nov 2, 2007
License(s)
209006840 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 274 | Dwight, IL 60420-0274 | 630-605-5234 |
| LOCATION | 313 ANDREW AVE | Dwight, IL 60420-1645 | 630-605-5234 |
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