Willis, Lacanda
Willis, Lacanda is an individual health care provider with primary practice located at 1507 E 53Rd St Suite 283, Chicago IL 60615-4509. She recently has only one registered license in Other Service Providers / Driver, which is considered as her primary health care specialty. Willis, Lacanda can be contacted via phone (773) 837-4163.Contact Information
Primary practice address
1507 E 53Rd St Suite 283
Chicago IL 60615-4509
Phone: (773) 837-4163
Fax: (708) 798-2454
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Driver | 172A00000X | Illinois |
Profile Details
| NPI number | 1528259959 |
|---|---|
| LBN Legal business name | Willis, Lacanda |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 9th, 2007 |
| Last updated | Aug 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528259959 | NPPES |
| Illinois | MEDICAID | 36435163002 |
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