Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 036.129852 | IL |
Y | 2080P0201X | Pediatric Allergist | 036.129852 | IL |
NPI | 1689998262 |
---|---|
Provider Name | Dr. Nana Sarkoah Fenny |
First Address | Burr Ridge, IL 60527-7594 |
Second Address | Chicago, IL 60637-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2010 |
Last Update Date | 02/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.129852 | STATE LICENSE (01) | IL |
051053 | LICENSE (01) | CT |