Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209014958 | IL |
NPI | 1063956365 |
---|---|
Provider Name | Emily Miller |
First Address | Chicago, IL 60603 |
Second Address | Chicago, IL 60603-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2016 |
Last Update Date | 24/07/2017 |