Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125063204 | IL |
N | 111NI0900X | Internist | 125063204 | IL |
Y | 207RH0000X | Hematologist | 042-0015171 | VT |
N | 207RX0202X | Medical Oncology | 042-0015171 | VT |
NPI | 1194164962 |
---|---|
Provider Name | Jacqueline Nicole Poston |
First Address | Chicago, IL 60637 |
Second Address | Burlington, VT 05401-1473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 01/12/2021 |