Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 209021561 | IL |
NPI | 1083222368 |
---|---|
Provider Name | Izolda Rosario |
First Address | Elmhurst, IL 60126-1419 |
Second Address | Elmhurst, IL 60126-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2020 |
Last Update Date | 22/07/2020 |