Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | IL |
NPI | 1003940461 |
---|---|
Provider Name | Mrs. Doris M Lawyer |
First Address | Champaign, IL 61822-8715 |
Second Address | Urbana, IL 61801-4703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |