| NPI | 1598416125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IEASHA NICKELSON RN/Owner 708-949-0969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 163W00000X Registered Nurse |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-01-14 |