Individual
MS. LACRESHA TENISHA MARIE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8954 S BISHOP ST, CHICAGO, IL 60620-4906
(773) 209-9201
Mailing address
8954 S BISHOP ST, CHICAGO, IL 60620-4906
(773) 209-9201
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
IL
Other
Enumeration date
02/20/2020
Last updated
02/20/2020
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