Individual
MRS. DOLMA TREESA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(224) 610-7567
(224) 610-7568
Mailing address
55 RUE FORET, LAKE FOREST, IL 60045-1543
(847) 370-0710
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
041.404168
IL
Other
Enumeration date
03/17/2023
Last updated
03/17/2023
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