Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | IL | |
Y | 1223P0300X | Periodontist | IL |
NPI | 1154421030 |
---|---|
Provider Name | Donna Marie Barber |
First Address | Chicago, IL 60602 |
Second Address | Chicago, IL 60602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |