Individual
NICOLE D'AMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10661 W LA PORTE RD, MOKENA, IL 60448-9475
(708) 925-3100
Mailing address
10661 W LA PORTE RD, MOKENA, IL 60448-9475
(708) 925-3100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041407135
IL
163W00000X
Registered Nurse
28208148A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28208148A
IN
Other
Enumeration date
03/11/2021
Last updated
02/23/2022
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