Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 019016857 | IL |
NPI | 1033581103 |
---|---|
Provider Name | Dr. Kathy Arkwell |
First Address | Peoria, IL 61614 |
Second Address | Peoria, IL 61614-2494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |