Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1467076398 |
---|---|
Provider Name | Ayesha Sconyers |
First Address | Chicago, IL 60619-7825 |
Second Address | Chicago, IL 60619-7825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2020 |
Last Update Date | 06/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123456789 | NONE (01) |