Individual
MRS. SAMANTHA NICHOLE LAYSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9600 GROSS POINT RD, SKOKIE, IL 60076-1214
(847) 677-9600
Mailing address
1235 S WHITE OAK DR APT 1635, WAUKEGAN, IL 60085-8358
(478) 301-9958
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008351
IL
Other
Enumeration date
05/11/2021
Last updated
03/11/2024
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