Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 036112985 | IL |
N | 207N00000X | Dermatologist | 4301104886 | MI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 4301104886 | MI |
N | 207NS0135X | Procedural Dermatology | 4301104886 | MI |
NPI | 1013933431 |
---|---|
Provider Name | Amy P Orsini |
First Address | Naperville, IL 60563-3161 |
Second Address | Naperville, IL 60563-3161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 09/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036112985 | IL STATE LIC (01) | IL |