| NPI | 1306280433 |
|---|---|
| Other Name | SA STATE STREET OB/GYN |
| Entity Type | Organization |
| Authorized Contact | DON DANIELS VP 815-966-2084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2018-07-12 |