Individual
LISA ANN WALDROUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1633 TINA LN, FLOSSMOOR, IL 60422-1952
(708) 922-1344
Mailing address
1633 TINA LN, FLOSSMOOR, IL 60422-1952
(708) 922-1344
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
043.1161135
IL
343900000X
Non-emergency Medical Transport (VAN)
Primary
07483562
IL
Other
Enumeration date
01/24/2019
Last updated
01/24/2019
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