Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2016012443 | MO |
Y | 2080P0207X | Pediatric Hematology-Oncologist | DO-05421 | IA |
NPI | 1184062457 |
---|---|
Provider Name | Laura Christine Mccarthy |
First Address | Peoria, IL 61615-7875 |
Second Address | Des Moines, IA 50309-1418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 26/11/2019 |