Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209.017480 | IL |
NPI | 1003303769 |
---|---|
Provider Name | Miss Maira Ochoa |
First Address | Harvey, IL 60426-3556 |
Second Address | Harvey, IL 60426-3556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209.017480 | ADVANCED PRACTICE NURSE LICENSE (01) | IL |