Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 209009513 | IL |
NPI | 1013275007 |
---|---|
Provider Name | Elizabeth Jeanne Robert |
First Address | Pontiac, IL 61764-2748 |
Second Address | Pontiac, IL 61764-2748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 09/12/2013 |