Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 036-133728 | IL |
N | 2080A0000X | Adolescent Medicine | A108940 | CA |
NPI | 1235451402 |
---|---|
Provider Name | Felicia Scott |
First Address | Chicago, IL 60612-3841 |
Second Address | Chicago, IL 60612-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2010 |
Last Update Date | 24/03/2014 |