Individual
NATHALIA MENICUCCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3940 N CLARK ST APT 407, CHICAGO, IL 60613-2625
(786) 222-5646
Mailing address
3940 N CLARK ST APT 407, CHICAGO, IL 60613-2625
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0630198732
—
IL
Enumeration date
12/19/2019
Last updated
12/19/2019
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