Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 209.023790 | IL |
NPI | 1003572322 |
---|---|
Provider Name | Hannah Alyce Prater |
First Address | Mount Zion, IL 62549-1115 |
Second Address | Decatur, IL 62522-1034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2021 |
Last Update Date | 10/11/2021 |