Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 036123513 | IL |
NPI | 1013068667 |
---|---|
Provider Name | Julie Lewis |
First Address | Normal, IL 61761-3558 |
Second Address | Normal, IL 61761-3558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 13/07/2009 |