Individual
VANESSA MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3002 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8200
Mailing address
421 FAIRLAWN DR, ROUND LAKE PARK, IL 60073-3116
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041415663
IL
Other
Enumeration date
03/12/2015
Last updated
03/12/2015
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