Individual
QUENTIN CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19712 CRESCENT AVE, LYNWOOD, IL 60411-1460
(773) 886-2626
Mailing address
19712 CRESCENT AVE, LYNWOOD, IL 60411-1460
(773) 886-2626
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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