Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 209018146 | IL |
NPI | 1083189823 |
---|---|
Provider Name | Courtney M Duffy |
First Address | Dixon, IL 61021-3116 |
Second Address | Dixon, IL 61021-3166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2018 |
Last Update Date | 08/10/2018 |