Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 038.013430 | IL |
NPI | 1356987168 |
---|---|
Provider Name | Dr. Alyssa Holum |
First Address | Westmont, IL 60559-1274 |
Second Address | Palatine, IL 60067-1837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2019 |
Last Update Date | 27/11/2019 |