Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 209.021733 | IL |
NPI | 1033722517 |
---|---|
Provider Name | Ambria Miner |
First Address | Chicago, IL 60623-2426 |
Second Address | Chicago, IL 60623-2426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2020 |
Last Update Date | 25/08/2020 |