| 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 |