Individual
SHYTIA LINCOLE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14706 AVALON AVE, DOLTON, IL 60419-2462
(708) 244-5131
Mailing address
14706 AVALON AVE, DOLTON, IL 60419-2462
(708) 244-5131
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6367-9281-940
DRIVER LICENSE
IL
Enumeration date
06/26/2017
Last updated
06/26/2017
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