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Individual

KANEYSHA MINDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875
Mailing address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
474579189001
IL
Enumeration date
04/25/2016
Last updated
08/02/2016
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