Individual
MISS TANIYAMOL JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2504 WASHINGTON ST STE 102, WAUKEGAN, IL 60085-4960
(847) 623-7590
Mailing address
8995 KENNEDY DR APT 1F, DES PLAINES, IL 60016-5400
(224) 616-0485
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019253
IL
Other
Enumeration date
08/27/2019
Last updated
04/26/2021
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