Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036.148113 | IL |
NPI | 1063856342 |
---|---|
Provider Name | Dr. Gretchen L Kopec |
First Address | Springfield, IL 62711-7865 |
Second Address | Peoria, IL 61637-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 03/02/2022 |