Individual
YVATNI BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5635 W ROOSEVELT RD, CICERO, IL 60804-1230
(708) 652-6500
Mailing address
7400 S HARVARD AVE, CHICAGO, IL 60621-3424
(773) 632-6229
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043130374
IL
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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