Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036150192 | IL |
Y | 2080P0214X | Pediatric Pulmonologist | 036150192 | IL |
NPI | 1316381924 |
---|---|
Provider Name | Kathleen Lynn Boyne |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 16/03/2021 |