Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 125.079014 | IL |
NPI | 1043889454 |
---|---|
Provider Name | Dr. Lauren Jessica Haney |
First Address | Champaign, IL 61820-4090 |
Second Address | Urbana, IL 61801-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2021 |
Last Update Date | 21/06/2021 |