| NPI | 1568260347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY L WILKES Medical Director 773-437-7816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-04-26 |