Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209.018061 | IL |
NPI | 1013491059 |
---|---|
Provider Name | Michelle Lee Castello |
First Address | Bloomingdale, IL 60108-2674 |
Second Address | Bloomingdale, IL 60108-2674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2018 |
Last Update Date | 15/09/2018 |