Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 209.018180 | IL |
NPI | 1194208108 |
---|---|
Provider Name | Maureen Welty |
First Address | Germantown Hills, IL 61548-8645 |
Second Address | Peoria, IL 61637-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2018 |
Last Update Date | 14/09/2018 |