| NPI | 1578748067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYA WILBANKS Office Manager 708-364-1550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2026-07-07 |