Organization
LIVE BOLD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BLOOD (OWNER)
(978) 877-0781
Entity
Organization
Contact information
Practice address
33 W DELAWARE PL, CHICAGO, IL 60610-8115
(978) 877-0781
Mailing address
33 W DELAWARE PLACE, CHICAGO, IL 60610
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209009533
IL
Other
Enumeration date
12/28/2016
Last updated
12/28/2016
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