Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 209012424 | IL |
NPI | 1013306240 |
---|---|
Provider Name | Jessica Wunder |
First Address | Smithville, MO 64089-9625 |
Second Address | Chicago, IL 60640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 14/06/2018 |