Individual
THEREASA SPACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA(ASCP)
Contact information
Practice address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2901
(219) 703-1784
Mailing address
2417 INDIANA AVE, LANSING, IL 60438
Taxonomy
Speciality
Code
Description
License number
State
246Q00000X
Pathology Specialist/Technologist
Primary
—
—
Other
Enumeration date
10/19/2022
Last updated
10/19/2022
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