Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209014938 | IL |
NPI | 1003348103 |
---|---|
Provider Name | Ivy Millar Enger |
First Address | Plainfield, IL 60586-7756 |
Second Address | Plainfield, IL 60586-7756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 05/02/2020 |