Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125-055756 | IL |
N | 111NI0900X | Internist | 125-055756 | IL |
N | 207RC0200X | Critical Care Medicine | 036129696 | IL |
Y | 207RP1001X | Pulmonary Disease | 036129696 | IL |
NPI | 1063647121 |
---|---|
Provider Name | Dr. Janice Chyi Ju-Hua Stanley |
First Address | Winfield, IL 60190-1295 |
Second Address | Winfield, IL 60190-1295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 15/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036129696 | (05) | IL |
206147 | MEDICARE PTAN (GROUP) (01) | IL |
F400224384 | MEDICARE PTAN (INDIVIDUAL) (01) | IL |