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Individual

WANDA PETTYE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3618 WESTERN AVE, PARK FOREST, IL 60466-2126
(708) 228-0999
Mailing address
3618 WESTERN AVE, PARK FOREST, IL 60466-2126
(708) 228-0999

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043071327
IL

Other

Enumeration date
08/03/2010
Last updated
08/03/2010
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