Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209.009189 | IL |
NPI | 1023385796 |
---|---|
Provider Name | Cristina Cacciatore |
First Address | Chicago, IL 60612 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2011 |
Last Update Date | 15/01/2020 |