Individual
MARY GRASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4254 W 55TH ST, CHICAGO, IL 60632-4642
(773) 582-5200
Mailing address
840 N SPRING AVE, LA GRANGE PARK, IL 60526-1475
(708) 525-4065
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209022601
IL
Other
Enumeration date
01/11/2021
Last updated
01/11/2021
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