Individual
CHRISTINE ILLECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2327 W DESIREE LN, TEMPE, AZ 85282-6128
(480) 848-2055
Mailing address
2327 W DESIREE LN, TEMPE, AZ 85282-6128
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
478188
CA
163W00000X
Registered Nurse
Primary
RN075194
AZ
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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