| NPI | 1720968415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIKITA MAHAN Owner 708-769-4062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-04 |