Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 209019326 | IL |
NPI | 1013339498 |
---|---|
Provider Name | Cayce Mcconnell |
First Address | Arlington Heights, IL 60005-2361 |
Second Address | Arlington Heights, IL 60005-2361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2014 |
Last Update Date | 05/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209019326 | IL APN LICENSE NUMBER (01) | IL |