Individual
MRS. LENY V CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16953 W SERRANDA DR, LIBERTYVILLE, IL 60048-9465
(847) 918-7663
Mailing address
16953 W SERRANDA DR, LIBERTYVILLE, IL 60048-9465
(847) 918-7663
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041346167
IL
363LP2300X
Primary Care Nurse Practitioner
209013196
IL
Other
Enumeration date
09/09/2015
Last updated
09/09/2015
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