Individual
IEASHA NICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1440 CLEAR DR, BOLINGBROOK, IL 60490-5575
(708) 949-0969
Mailing address
1112 W BOUGHTON RD STE 249, BOLINGBROOK, IL 60440-1508
(708) 949-0969
Taxonomy
Speciality
Code
Description
License number
State
163WX0106X
Occupational Health Registered Nurse
Primary
041393629
IL
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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