Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209.007309 | IL |
NPI | 1235366402 |
---|---|
Provider Name | Dr. Mary Lynn Puchalski |
First Address | Lombard, IL 60148-5148 |
Second Address | Winfield, IL 60190-1222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 23/02/2020 |