Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 65711-20 | WI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036143419 | IL |
NPI | 1174943666 |
---|---|
Provider Name | Amanda Christine Becker |
First Address | Chicago, IL 60611-2909 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 17/03/2018 |