Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist | 209001980 | IL |
NPI | 1619586518 |
---|---|
Provider Name | Lisa K Anderson-Shaw |
First Address | Chicago, IL 60601-8026 |
Second Address | Berwyn, IL 60402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2020 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
53653162873A | STATE DRIVERS LICENCE (01) | IL |