Individual
LACEY MANIMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1026 GUNDERSON AVE, OAK PARK, IL 60304-2118
(312) 509-1616
Mailing address
1026 GUNDERSON AVE, OAK PARK, IL 60304-2118
(312) 509-1616
Taxonomy
Speciality
Code
Description
License number
State
163WX0002X
High-Risk Obstetric Registered Nurse
041.447143
IL
367A00000X
Advanced Practice Midwife
Primary
209030375
IL
Other
Enumeration date
08/20/2024
Last updated
09/12/2024
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