Individual
MICHELLE GAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17316 CENTRAL PARK AVE, HAZEL CREST, IL 60429-1508
(708) 275-9890
Mailing address
17316 CENTRAL PARK AVE, HAZEL CREST, IL 60429-1508
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041336187
IL
163W00000X
Registered Nurse
28182305A
IN
Other
Enumeration date
01/07/2016
Last updated
01/07/2016
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