Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 036088359 | IL |
N | 208000000X | Pediatrician | 36088359 | IL |
NPI | 1518931492 |
---|---|
Provider Name | Carolyn Jones |
First Address | Winfield, IL 60190-2756 |
Second Address | Winfield, IL 60190-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036088359 | (05) | IL |
36088359 | (05) | IL |
G84314 | (02) |