Organization
EVOLVE NURSE CONSULTANT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IEASHA NICKELSON REGISTERED NURSE (RN/OWNER)
(708) 949-0969
Entity
Organization
Contact information
Practice address
1440 CLEAR DR, BOLINGBROOK, IL 60490-5575
(708) 949-0969
Mailing address
1112 W BOUGHTON RD STE 249, BOLINGBROOK, IL 60440-1508
(708) 949-0969
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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