DESIREE MICHELLE PROVAX

CHICAGO, IL
NPI1942760962
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: IL  209.018899)
Enumeration Date2019-03-25
Last Update Date2019-03-25
Business Address
DESIREE MICHELLE PROVAX APN
5237 W WINDSOR AVE
CHICAGO, IL 60630-3720
Phone number: 773-547-3544
Mailing Address
DESIREE MICHELLE PROVAX APN
5237 W WINDSOR AVE
CHICAGO, IL 60630-3720
Phone number: 773-547-3544
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