Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 209018959 | IL |
NPI | 1063061745 |
---|---|
Provider Name | Harley Cortes Salinas |
First Address | Mt. Prospect, IL 60056-1411 |
Second Address | Chicago, IL 60612-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2019 |
Last Update Date | 21/06/2020 |