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 |