Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | IL |
NPI | 1033126008 |
---|---|
Provider Name | Lynn Rae Mershon |
First Address | Elgin, IL 60123 |
Second Address | Elgin, IL 60123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4921788 | BLUE CROSS BLUE SHIELD (01) | IL |
F91908 | (02) |