Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209-009752 | IL |
NPI | 1003164617 |
---|---|
Provider Name | Melissa Hajostek |
First Address | Galesburg, IL 61401-1251 |
Second Address | Galesburg, IL 61401-1251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 29/08/2012 |