| NPI | 1235374919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE MORENO Credentialing Specialist 773-586-4506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2008-12-09 |