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Individual

MRS. LISA MARIE VANDER WALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.N., CF-M

Contact information

Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-2058
Mailing address
804 BELOT LN, NEW LENOX, IL 60451-9258
(815) 485-5567

Taxonomy

Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
Primary
IL

Other

Enumeration date
02/16/2007
Last updated
07/08/2007
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