Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036147108 | IL |
N | 207RG0300X | Geriatric Medicine | 45902 | MN |
NPI | 1083675045 |
---|---|
Provider Name | Aimee C Yu-Ballard |
First Address | Urbana, IL 61801-2529 |
Second Address | Urbana, IL 61802-9566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 12/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016637500 | (05) | MN |
H94550 | (02) |