Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | IL |
NPI | 1023168515 |
---|---|
Provider Name | Dr. Jane Taylor Greenfield |
First Address | Rockford, IL 61107-1366 |
Second Address | Rockford, IL 61114-6315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10132119 | BLUECROSS BLUESHIELD (01) | IL |