Individual
NAKIESHA WALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
807 RIDGE DR # 520, DEKALB, IL 60115-1385
(815) 508-7131
Mailing address
835 EDGEBROOK DR APT 115, DEKALB, IL 60115-1446
(815) 508-7131
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
W4356-3797-698
IL
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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