NPI 1063109296

Larone Nutall

Practitioner Contractor Chicago, IL

Practice location

Address: 7138 S Coles Ave APT 2a, Chicago, IL 60649-2628
Phone: (708) 915-0517
Mailing address: PO Box 490563, Chicago, IL 60649-0035

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 095808 (IL)

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Registry record

NPI: 1063109296
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Apr 2023
Record last updated: 19 Apr 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.