Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | IL |
NPI | 1649202243 |
---|---|
Provider Name | Dr. Bridget Lybarger |
First Address | Belleville, IL 62223-3811 |
Second Address | Belleville, IL 62223-3811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |