Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036101828 | IL |
NPI | 1518934967 |
---|---|
Provider Name | Jacqueline Moran |
First Address | Chicago, IL 60674-0018 |
Second Address | Glen Ellyn, IL 60137-4464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036101828 | (05) | IL |