Individual
MARY MIKELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN BSN
Contact information
Practice address
16005 AVALON AVE, SOUTH HOLLAND, IL 60473-1865
(708) 964-6135
Mailing address
16005 AVALON AVE, SOUTH HOLLAND, IL 60473-1865
(708) 964-6135
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041398510
IL
Other
Enumeration date
05/14/2021
Last updated
05/14/2021
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