Individual
ESTEFANA HUERTA SHAVISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
904 E MAIN ST, DU QUOIN, IL 62832-2521
(618) 317-0985
Mailing address
904 E MAIN ST, DU QUOIN, IL 62832-2521
(618) 317-0985
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
04/30/2020
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