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Individual

MS. LINDA ZORAIDA GENSAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NONE

Contact information

Practice address
12406 CEDAR LAKE RD, CROWN POINT, IN 46307-8736
(773) 818-8060
Mailing address
12406 CEDAR LAKE RD, CROWN POINT, IN 46307-8736
(773) 818-8060

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
1830-23-8598
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101785485099
IN
Enumeration date
07/23/2013
Last updated
07/23/2013
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