| NPI | 1770065765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAIDEE MAURA POLGAR Owner 331-725-1352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209016112) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209016112) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209016112) | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2018-09-05 |