Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209009990 | IL |
NPI | 1093069593 |
---|---|
Provider Name | Anne Marie Perez |
First Address | Chicago, IL 60611-2927 |
Second Address | Chicago, IL 60611-2927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2012 |
Last Update Date | 05/11/2012 |