Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016-004462 | IL |
Y | 222Z00000X | Podiatrist | 016-004462 | IL |
NPI | 1063579472 |
---|---|
Provider Name | Dr. Ada Vera Paolucci |
First Address | Joliet, IL 60435-1617 |
Second Address | Joliet, IL 60435-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 20/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U12020 | (02) | IL |