Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | IL | |
Y | 222Z00000X | Podiatrist | IL |
NPI | 1013928365 |
---|---|
Provider Name | Dr. Christine Celeste Kancius |
First Address | Peoria, IL 61616 |
Second Address | Morton, IL 61550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DA0891 | PALMETTO GBA- RAILROAD ME (01) | IL |
L97270 | (02) |