Individual
WANDA NICOLE TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
95 W MEADOW DR, CORTLAND, IL 60112-4230
(312) 307-1651
Mailing address
95 W MEADOW DR, CORTLAND, IL 60112-4230
(312) 307-1651
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T35091465782
IL
Other
Enumeration date
01/27/2025
Last updated
01/27/2025
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