Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 096.003920 | IL |
Y | 213ES0000X | Sports Medicine | 096.003920 | IL |
NPI | 1457854119 |
---|---|
Provider Name | Arielle Willett |
First Address | Plainfield, IL 60544-6053 |
Second Address | Oak Park, IL 60302-4005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |