Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 52942-20 | WI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036.133125 | IL |
NPI | 1104030659 |
---|---|
Provider Name | Joanne Kristine Claveria |
First Address | Park Ridge, IL 60068-1143 |
Second Address | Park Ridge, IL 60068-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 31/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104030659 | (05) | WI |