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Lawanda Wallace
Private Vehicle in Chicago, Illinois
NPI 1154788875

Lawanda Wallace is a Private Vehicle based in Chicago, IL. Lawanda Wallace practices in Chicago, IL. The NPI Number for Lawanda Wallace is 1154788875 and holds a License No. W42053371706 (Illinois).

The current practice location address for Lawanda Wallace is 11559 S Oakley Ave, Chicago, IL and can be reached out via phone at 773-391-6689.

Location: 11559 S Oakley Ave, Chicago, IL, 60643-4721
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1154788875
Provider Name
Lawanda Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
11559 S Oakley Ave, Chicago, IL, 60643-4721
Phone Number
773-391-6689
Fax Number
Provider Enumeration Date
01/26/2016
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
11559 S Oakley Ave
City
Chicago
State
Illinois
Zip
60643-4721
Phone Number
773-391-6689
Fax Number
person
Provider Business Mailing Address Details
Address
11559 S Oakley Ave
City
Chicago
State
Illinois
Zip
60643-4721
Phone Number
773-391-6689
Fax Number
person
Provider's Taxonomy Details 1
Type
Transportation Services
Classification
Private Vehicle
Speciality
-
Taxonomy
347C00000X
License No.
W42053371706 (Illinois)
Definition
An individual paid to provide non-emergency transportation using their privately owned/leased vehicle.
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