| NPI | 1235411703 |
|---|---|
| Doing Business As | PROVISO FAMILY SERVICES INC |
| Entity Type | Organization |
| Authorized Contact | MELVONNE WICKLIFFE-JONES Credentialing Mgr 630-914-2417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2013-04-09 |