Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | IL |
NPI | 1316099070 |
---|---|
Provider Name | Dr. Jennifer Mcnulty |
First Address | Glen Ellyn, IL 60137-4616 |
Second Address | Naperville, IL 60540-7430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |