Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209018702 | IL |
NPI | 1003371691 |
---|---|
Provider Name | Emily Remington |
First Address | Urbana, IL 61801-2529 |
Second Address | Urbana, IL 61801-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2019 |
Last Update Date | 07/02/2019 |