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Individual

TRINITY WALLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
111 W JACKSON BLVD STE 1700, CHICAGO, IL 60604-3597
(888) 731-8994
Mailing address
PO BOX 1014, MATTESON, IL 60443-4014

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277.002315
IL
363LW0102X
Women's Health Nurse Practitioner
209.018941
IL
363LW0102X
Women's Health Nurse Practitioner
277.002315
IL

Other

Enumeration date
06/07/2019
Last updated
01/14/2025
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