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1114471885
MILDRED MARIE PORTER
CHICAGO, IL
NPI
1114471885
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: IL 209013926)
Enumeration Date
2016-08-10
Last Update Date
2016-08-10
Business Address
-- MILDRED MARIE PORTER
2259 S WESTERN AVE APT 2
CHICAGO, IL 60608-4476
Phone number: 312-738-3355
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Mailing Address
-- MILDRED MARIE PORTER
14442 ABBOTTSFORD RD
MIDLOTHIAN, IL 60445-2902
Phone number: 708-371-7817
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