Individual
TANISHA COPELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1472 S 3RD AVE, KANKAKEE, IL 60901-4915
(815) 386-4940
Mailing address
1472 S 3RD AVE, KANKAKEE, IL 60901-4915
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
09/11/2017
Last updated
09/11/2017
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