Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 49931 | AZ |
NPI | 1104137702 |
---|---|
Provider Name | Amanda Tower |
First Address | Chicago, IL 60640-4731 |
Second Address | North Chicago, IL 60064-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 04/05/2021 |