Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209022677 | IL |
NPI | 1003465162 |
---|---|
Provider Name | Emily Rhoades |
First Address | Springfield, IL 62703-2403 |
Second Address | Decatur, IL 62526-4766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2019 |
Last Update Date | 02/02/2021 |