Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 036-103460 | IL |
NPI | 1114060548 |
---|---|
Provider Name | Dr. Anette K. Mnabhi |
First Address | Montgomery, IL 60538-1298 |
Second Address | Montgomery, IL 60538-1298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 14/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4727796 | BLUE CROSS (01) | IL |
H46209 | (02) |