Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209.016368 | IL |
NPI | 1003334459 |
---|---|
Provider Name | Miss Whitney Mcguire |
First Address | Carbondale, IL 62902-3988 |
Second Address | Carbondale, IL 62901-1474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 29/01/2021 |