Individual
SHAUNTRESE PORCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9149 S ALBANY AVE, EVERGREEN PARK, IL 60805-1718
(773) 320-7757
Mailing address
PO BOX 508, OAK LAWN, IL 60454-0508
(773) 320-7757
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041320318
IL
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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