Individual
LATABITHA BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10736 LAMON AVE, OAK LAWN, IL 60453-5419
(773) 791-5364
Mailing address
10736 LAMON AVE, OAK LAWN, IL 60453-5419
(773) 791-5364
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
041528835
IL
Other
Enumeration date
09/20/2024
Last updated
09/20/2024
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