Individual
GRACE DIALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3710 LISMORE ST, FLOSSMOOR, IL 60422-4311
(708) 527-0354
Mailing address
3710 LISMORE ST, FLOSSMOOR, IL 60422-4311
(708) 527-0354
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.024830
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013663178
—
IL
Enumeration date
02/28/2022
Last updated
04/04/2022
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