Individual
CARLA MAHMUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8207 22ND AVE, KENOSHA, WI 53143-6206
(224) 610-8900
Mailing address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043103091
IL
Other
Enumeration date
03/07/2023
Last updated
03/07/2023
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