Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 036081330 | IL |
Y | 2080P0204X | Pediatric Emergency Doctor | 036081330 | IL |
NPI | 1275593253 |
---|---|
Provider Name | Elizabeth C Powell |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036081330 | (05) | IL |
I00618 | (02) |