Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036092063 | IL |
NPI | 1023093572 |
---|---|
Provider Name | Heather Cushing |
First Address | Glen Ellyn, IL 60137-5839 |
Second Address | Glen Ellyn, IL 60137-5839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L007237 | CHAMPUS (01) | IL |