Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209.022309 | IL |
NPI | 1477135374 |
---|---|
Provider Name | Michelle Summer Jones |
First Address | Chicago, IL 60657-5967 |
Second Address | Chicago, IL 60631-3707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2021 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209.022309 | APN LICENSE (01) | IL |