Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036131177 | IL |
NPI | 1134311087 |
---|---|
Provider Name | Dr. Jacquelyn Michelle Sturm |
First Address | Shiloh, IL 62269-2993 |
Second Address | Shiloh, IL 62269-2993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 22/10/2013 |