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Individual

SHANANDISS HAMPTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
714 HARRISON CT, CRETE, IL 60417-2884
(918) 856-7200
Mailing address
714 HARRISON CT, CRETE, IL 60417-2884
(918) 856-7200

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
M083702694
IL
Enumeration date
02/05/2021
Last updated
02/05/2021
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