Individual
JOSE MARIE CORNELIO DERLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2400 MICHAEL AVE, ZION, IL 60099-9224
(224) 353-9424
Mailing address
2400 MICHAEL AVE, ZION, IL 60099-9224
(224) 353-9424
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
041.359360
IL
Other
Enumeration date
06/18/2010
Last updated
06/18/2010
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