Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 209023887 | IL |
NPI | 1003450354 |
---|---|
Provider Name | Chelsea Hartzell |
First Address | Lena, IL 61048-9624 |
Second Address | Lena, IL 61048-9624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 02/11/2021 |