NPI | 1689881450 |
---|---|
Entity Type | Organization |
Authorized Contact | KELLY E. DIETRICH Practice Manager 847-679-3411 |
Organization Subpart ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 20905900) |
Enumeration Date | 2007-05-17 |
Last Update Date | 2020-08-22 |