Individual
LOLITA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14235 S WALLACE AVE, RIVERDALE, IL 60827-2324
(708) 439-9981
Mailing address
14235 S WALLACE AVE, RIVERDALE, IL 60827-2324
(708) 439-9981
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043068995
IL
Other
Enumeration date
12/06/2016
Last updated
12/06/2016
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