Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036092889 | IL |
NPI | 1407955214 |
---|---|
Provider Name | Dr. Stacie A Mcmurtry |
First Address | Gurnee, IL 60031-4571 |
Second Address | Libertyville, IL 60048-5266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G78888 | (02) | IL |