Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209021688 | IL |
NPI | 1003409491 |
---|---|
Provider Name | Emily Ann Loutfy |
First Address | Highland Park, IL 60035-3109 |
Second Address | Highland Park, IL 60035-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2021 |
Last Update Date | 24/02/2021 |