Individual
DIESAWIT T HANSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1366 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3795
(847) 236-0323
Mailing address
1366 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3795
(847) 236-0323
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
277.004265
IL
Other
Enumeration date
10/20/2022
Last updated
06/12/2025
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