Most Relevant Information
Provider Data
| NPI Number: | 1003442898 |
| Provider Name: | SHAYNA ROSE WALDBAUM |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/12/2020 |
| Last Updated: | 03/12/2020 |
Provider Practice Location
3333 GREEN BAY RD
NORTH CHICAGO
IL
600643037
Practice Location Phone/Fax
| Phone: | 8475783000 |
| Fax: |
Provider Mailing Location
3333 GREEN BAY RD
NORTH CHICAGO
IL
600643037
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |