Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 209014109 | IL |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 209014109 | IL |
NPI | 1003365842 |
---|---|
Provider Name | Laurie Peercy |
First Address | Atlanta, GA 30374-6721 |
Second Address | Chicago, IL 60624-2895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2016 |
Last Update Date | 07/10/2020 |