Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1075 | MN |
NPI | 1063974004 |
---|---|
Provider Name | Lisa Krebs |
First Address | Chicago, IL 60618-5915 |
Second Address | Lombard, IL 60148-6104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 01/04/2019 |