Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209001455 | IL |
NPI | 1003994385 |
---|---|
Provider Name | Janis Ostiguy |
First Address | Urbana, IL 61803-6002 |
Second Address | Danville, IL 61832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 21/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S89817 | (02) | IL |