Individual
MRS. NANCY ALICE WAHLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSFA/CST
Contact information
Practice address
2730 BRASSIE AVE, FLOSSMOOR, IL 60422-1822
(708) 363-1317
Mailing address
2730 BRASSIE AVE, FLOSSMOOR, IL 60422-1822
(708) 363-1317
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
03/05/2012
Last updated
03/05/2012
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