DESIREE MICHELLE PROVAX

CHICAGO, IL
NPI1942760962
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: IL  209018899)
Additional Taxonomies363LF0000X Nurse Practitioner, Family
(Licence: IL  209018899)
Enumeration Date2019-03-25
Last Update Date2025-11-21
Business Address
DESIREE MICHELLE PROVAX APN
5145 N CALIFORNIA AVE STE 331
CHICAGO, IL 60625-3661
Phone number: 847-570-1027
Mailing Address
DESIREE MICHELLE PROVAX APN
2650 RIDGE AVE STE 1223
EVANSTON, IL 60201-1700
Phone number: 847-982-6715