Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 36075845 | IL |
NPI | 1124005954 |
---|---|
Provider Name | Ann Vertovec |
First Address | Lake Forest, IL 60045-1659 |
Second Address | Chicago, IL 60675-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36075845 | (05) | IL |
E30858 | (02) | IL |