Individual
KANDISE ROSE MARIE MOONEYHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 TEMPLETON DR, OSWEGO, IL 60543-7000
(630) 554-3456
(630) 551-2970
Mailing address
28594 NETWORK PL, CHICAGO, IL 60673-1285
(630) 859-6800
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041452140
IL
363LF0000X
Family Nurse Practitioner
Primary
209028373
IL
Other
Enumeration date
07/14/2023
Last updated
02/08/2024
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