Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036149483 | IL |
NPI | 1013354760 |
---|---|
Provider Name | Diana Constanza Hengartner |
First Address | Winfield, IL 60190-1295 |
Second Address | Winfield, IL 60190-1295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 12/07/2019 |