Individual
LIAUW DEVI GUNAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3412 W FULLERTON AVE, CHICAGO, IL 60647-2416
(773) 235-8000
Mailing address
8436 DRAKE AVE, SKOKIE, IL 60076-2800
(847) 329-0279
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.017128
IL
Other
Enumeration date
09/19/2018
Last updated
09/19/2018
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