Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 3011603 | KY |
NPI | 1013433366 |
---|---|
Provider Name | Mary Kathleen Lanoue |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40207-4721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2017 |
Last Update Date | 20/09/2019 |