Individual
MS. SAMUELLA MCKNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12442 S WALLACE ST, CHICAGO, IL 60628-7128
(773) 264-3057
Mailing address
12442 S WALLACE ST, CHICAGO, IL 60628-7128
(773) 264-3057
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043048239
IL
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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