Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036082689 | IL |
N | 111NI0900X | Internist | 036082689 | IL |
Y | 207RI0200X | Infectious Disease | 036082689 | IL |
NPI | 1063843670 |
---|---|
Provider Name | Dr. Jenie Nepomuceno |
First Address | Mchenry, IL 60050-8436 |
Second Address | Mchenry, IL 60050-8439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2013 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036082689 | (05) | IL |