Provider Information for 1235705450
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Dr. BONITA HUSBAND CRC
Sex: Female
NPI: 1235705450
Last Updated: 2021-05-28
Certification Date: 2021-05-28
Certification Date: 2021-05-28
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1235705450 | ||||||||||||||
| Enumeration Date | 2021-05-28 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 7 E CARRIAGEWAY DR # 503 HAZEL CREST, IL 60429-2032 United States Phone: 773-383-7907 | Fax: | ||||||||||||||
| Primary Practice Address | 7 E CARRIAGEWAY DR # 503 HAZEL CREST, IL 60429-2032 United States Phone: 773-383-7907 | Fax: | ||||||||||||||
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