| NPI | 1891185971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI ANN MENDOZA MORENO Nurse Practitioner 224-306-1879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209009279) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2015-04-20 |