Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1770023202 |
---|---|
Provider Name | Dr. Amanda Lea Fortier |
First Address | Rosemont, IL 60018-5305 |
Second Address | Rosemont, IL 60018-5305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2017 |
Last Update Date | 02/03/2017 |