Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209-011866 | IL |
N | 363LC1500X | Nurse Practitioner - Community Health | 209011866 | IL |
NPI | 1780063917 |
---|---|
Provider Name | Linda Tanni |
First Address | Gurnee, IL 60031-5659 |
Second Address | Gurnee, IL 60031-5659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 10/05/2021 |