Individual
CAROLLE M DERRADJI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3256 W POTOMAC AVE, CHICAGO, IL 60651-2411
(708) 280-6164
Mailing address
3256 W POTOMAC AVE, CHICAGO, IL 60651-2411
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.022245
IL
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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