| NPI | 1730559626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUVINI DE VAS GUNAWARDHANE Family Nurse Practitioner 847-686-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.011230) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2015-10-05 |