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Individual

STEVNIKA RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5517 N KENMORE AVE, CHICAGO, IL 60640-1515
(773) 275-7962
Mailing address
10929 S KEATING AVE APT 3N, OAK LAWN, IL 60453-6262
(312) 860-8459

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043-104842
IL

Other

Enumeration date
04/28/2018
Last updated
04/28/2018
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