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Individual

VIOLET CORINNE BOOTHE WIERSUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN, CNP

Contact information

Practice address
676 N SAINT CLAIR ST STE 14-044, CHICAGO, IL 60611-2927
(312) 908-8163
(312) 695-1394
Mailing address
676 N SAINT CLAIR ST STE 14-044, CHICAGO, IL 60611-2927
(312) 908-8163
(312) 695-1394

Taxonomy

Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
041421701
IL
363L00000X
Nurse Practitioner
Primary
209025108
IL
363LA2100X
Acute Care Nurse Practitioner
209025108
IL

Other

Enumeration date
02/02/2022
Last updated
09/21/2022
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