Individual
DEATRICE LAVONNA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
043117036
IL
164X00000X
Licensed Vocational Nurse
Primary
043117036
IL
Other
Enumeration date
10/16/2017
Last updated
10/16/2017
Update your record
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