Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036 056024 | IL |
NPI | 1003851692 |
---|---|
Provider Name | Dr. Pauline Harding |
First Address | Warrenville, IL 60555-1301 |
Second Address | Warrenville, IL 60555-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 04/02/2022 |