Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209010770 | IL |
NPI | 1023446770 |
---|---|
Provider Name | Kerin Cummins |
First Address | Rockford, IL 61102-2112 |
Second Address | Rockford, IL 61102-2112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 16/10/2013 |