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Individual

KENISHA QUIANA GRANDISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
5841 S MARYLAND AVE # MC2115, CHICAGO, IL 60637-1447
(773) 834-0475
(773) 753-4525
Mailing address
5841 S MARYLAND AVE # MC2115, CHICAGO, IL 60637-1447
(773) 834-0475
(773) 753-4525

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209015880
IL

Other

Enumeration date
05/11/2017
Last updated
04/01/2020
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