Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 125065238 | IL |
Y | 207VE0102X | Reproductive Endocrinologist | 036156432 | IL |
NPI | 1467870261 |
---|---|
Provider Name | Dr. Jessica Ruth Walter |
First Address | Chicago, IL 60611-3907 |
Second Address | Chicago, IL 60611-3907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 23/09/2021 |