Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 135.000965 | IL |
Y | 222Z00000X | Podiatrist | 135.000965 | IL |
NPI | 1043730625 |
---|---|
Provider Name | Mary Elizabeth Hickner |
First Address | Chicago, IL 60625-2508 |
Second Address | Chicago, IL 60625-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2017 |
Last Update Date | 23/06/2017 |