Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036133948 | IL |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 2013010803 | MO |
NPI | 1316150907 |
---|---|
Provider Name | Laura Kathryn Vricella |
First Address | Urbana, IL 61801 |
Second Address | Urbana, IL 61801-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 29/01/2021 |