Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 041-272502 | IL |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209-001305 | IL |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 041-272502 | IL |
NPI | 1063533388 |
---|---|
Provider Name | Jantanee Songkum |
First Address | Chicago, IL 60612-3714 |
Second Address | Chicago, IL 60612-3714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 30/04/2021 |