Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036098334 | IL |
NPI | 1215029582 |
---|---|
Provider Name | Dr. Jean M. Kriz |
First Address | Rockford, IL 61108-2425 |
Second Address | Rockford, IL 61108-2425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 11/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036098334 | (05) | IL |
H67822 | (02) | IL |