Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209-009627 | IL |
NPI | 1003219932 |
---|---|
Provider Name | Linda Schmidgall |
First Address | Peoria, IL 61603-3105 |
Second Address | Peoria, IL 61603-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2014 |
Last Update Date | 13/10/2014 |