Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209012440 | IL |
NPI | 1003205600 |
---|---|
Provider Name | Amy Miner |
First Address | Mt Prospect, IL 60056-6039 |
Second Address | Mt Prospect, IL 60056-6039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 20/10/2016 |