Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209-000229 | IL |
NPI | 1013046564 |
---|---|
Provider Name | Anna Dowd |
First Address | River Forest, IL 60305-1602 |
Second Address | River Forest, IL 60305-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 21/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P77638 | (02) | IL |