Individual
TIFFANY BURKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 175TH ST, HAZEL CREST, IL 60429-1604
(708) 654-6921
Mailing address
3300 175TH ST, HAZEL CREST, IL 60429-1604
(708) 654-6921
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043090801
IL
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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