Individual
SHAWNICE Y WAIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21645 OLIVIA AVE, SAUK VILLAGE, IL 60411-4426
(708) 748-5700
(708) 748-4245
Mailing address
21645 OLIVIA AVE, SAUK VILLAGE, IL 60411-4426
(708) 748-5700
(708) 748-4245
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/26/2009
Last updated
05/26/2009
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