Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209.016490 | IL |
NPI | 1003320128 |
---|---|
Provider Name | Mrs. Anasooyadevi Vijay |
First Address | Schaumburg, IL 60194-3620 |
Second Address | Schaumburg, IL 60194-3620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 28/11/2017 |