Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | IL | |
Y | 213EG0000X | General Practice | IL |
NPI | 1003873738 |
---|---|
Provider Name | Laura C Mears |
First Address | Anna, IL 62906-1668 |
Second Address | Cobden, IL 62920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |