Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209.007209 | IL |
NPI | 1013114511 |
---|---|
Provider Name | Angela Marie Jeffries |
First Address | Naperville, IL 60564-5802 |
Second Address | Naperville, IL 60564-5802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 22/07/2009 |