Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | IL |
NPI | 1083607881 |
---|---|
Provider Name | Dr. Nancy R Glick |
First Address | Evanston, IL 60201-2020 |
Second Address | Chicago, IL 60608-1732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-093186-2 | (05) | IL |
G15068 | (02) | IL |