Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209016649 | IL |
NPI | 1003323254 |
---|---|
Provider Name | Gay Bautista |
First Address | Schaumburg, IL 60173-4761 |
Second Address | Schaumburg, IL 60173-4761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 06/04/2018 |