| NPI | 1205017373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C TUCKER Program Director 815-284-3940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 0041206004) |
| Enumeration Date | 2007-11-17 |
| Last Update Date | 2007-11-17 |