Individual
KELLY TAIS AZAMBUJA CACHOEIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2151 WAUKEGAN RD STE 100, BANNOCKBURN, IL 60015-1885
(847) 444-5300
Mailing address
2151 WAUKEGAN RD STE 100, BANNOCKBURN, IL 60015-1885
(847) 444-5300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209029354
IL
Other
Enumeration date
02/13/2024
Last updated
08/07/2024
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