Individual
TIBESSA LAWRENCE-ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
835 S WOLCOTT AVE # E144, CHICAGO, IL 60612-3748
(312) 996-7420
Mailing address
2119 S 24TH AVE, BROADVIEW, IL 60155-2823
(708) 223-0873
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277.003029
IL
Other
Enumeration date
11/10/2014
Last updated
11/07/2024
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