Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 125-056999 | IL |
Y | 207VX0000X | Obstetrician | A132809 | CA |
NPI | 1073822573 |
---|---|
Provider Name | Alyssa Van Dyk |
First Address | Chicago, IL 60616-4737 |
Second Address | Palm Springs, CA 92262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 23/07/2018 |