Individual
TANISHA ANTONIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
195 WAUKEGAN RD UNIT 371, GLENVIEW, IL 60025-5186
(773) 562-2182
Mailing address
195 WAUKEGAN RD UNIT 371, GLENVIEW, IL 60025-5186
(773) 562-2182
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209022995
IL
Other
Enumeration date
03/14/2021
Last updated
03/14/2021
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