Miss Takala B Fomond, LPN | |
2916 Central St # 2, Evanston, IL 60201-1212 | |
(224) 420-6894 | |
Not Available |
Full Name | Miss Takala B Fomond |
---|---|
Gender | Female |
Speciality | Licensed Practical Nurse |
Location | 2916 Central St # 2, Evanston, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1215685565 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
164W00000X | Licensed Practical Nurse | 043.117753 (Illinois) | Primary |
Mailing Address | Practice Location Address |
---|---|
Miss Takala B Fomond, LPN 2916 Central St # 2a, Evanston, IL 60201-1212 Ph: (224) 420-6894 | Miss Takala B Fomond, LPN 2916 Central St # 2, Evanston, IL 60201-1212 Ph: (224) 420-6894 |
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