Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1225638877 |
---|---|
Provider Name | Christine Marie Desparrois |
First Address | Chicago, IL 60638-3458 |
Second Address | Hines, IL 60141-3030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2020 |
Last Update Date | 31/10/2020 |