Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 209015152 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209015152 | IL |
NPI | 1265974604 |
---|---|
Provider Name | Julie Borjon |
First Address | Springfield, IL 62701-1034 |
Second Address | Springfield, IL 62701-1034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2016 |
Last Update Date | 03/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F400350407 | RAILROAD (01) | IL |