Individual
DEMETRIUS CORNELL NANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 WASHINGTON ST, WAUKEGAN, IL 60085-5564
(847) 441-5600
Mailing address
405 CENTRAL AVE, NORTHFIELD, IL 60093-3006
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/28/2022
Last updated
06/22/2023
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