Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 209-014168 | IL |
NPI | 1003096918 |
---|---|
Provider Name | June R. Losurdo |
First Address | Hinsdale, IL 60521-3635 |
Second Address | Hinsdale, IL 60521-3635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 06/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1912218850 | GROUP PRACTICE NPI (01) | IL |
F400296540 | MEDICARE PTAN LOC16 (01) | IL |
F400296542 | MEDICARE PTAN LOC15 (01) | IL |