Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036084365 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 036084365 | IL |
NPI | 1346384534 |
---|---|
Provider Name | Karen A Jackson |
First Address | Glenview, IL 60026-1324 |
Second Address | Glenview, IL 60026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 06/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14093 | (02) | IL |