| NPI | 1942219514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESE LUCIETTO-SIERADZKI Owner 815-544-0087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2017-03-31 |