Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F1016781 | IL |
NPI | 1003368606 |
---|---|
Provider Name | Margarita Vega Suarez |
First Address | Munster, IN 46321-2907 |
Second Address | Munster, IN 46321-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2016 |
Last Update Date | 15/01/2017 |