Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209017070 | IL |
NPI | 1003304064 |
---|---|
Provider Name | Jennifer Lynn Laubscher |
First Address | Champaign, IL 61820-3981 |
Second Address | Champaign, IL 61822-6217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2018 |
Last Update Date | 05/01/2022 |