Individual
GRACE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 GREEN BAY RD, NORTH CHICAGO, IL 60064-3037
(915) 248-9527
Mailing address
3333 GREEN BAY RD, NORTH CHICAGO, IL 60064-3037
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
041582823
IL
Other
Enumeration date
08/15/2025
Last updated
08/15/2025
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