Individual
ELISSA DIESTELKAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28 WINGATE DR, OSWEGO, IL 60543-7911
(630) 768-5685
Mailing address
28 WINGATE DR, OSWEGO, IL 60543-7911
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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