Individual
MS. ALICIA KAY VANDER WAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1015 W LAWRENCE AVE FL 2, CHICAGO, IL 60640-5017
(773) 751-1731
(773) 275-3695
Mailing address
4368 72ND AVE, ZEELAND, MI 49464-9459
(616) 848-0402
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041478493
IL
163W00000X
Registered Nurse
4704315107
MI
Other
Enumeration date
03/29/2019
Last updated
04/24/2019
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