Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209.015189 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 277001372 | IL |
NPI | 1003359795 |
---|---|
Provider Name | Mrs. Helen Marie Muchow |
First Address | Cary, IL 60013-1907 |
Second Address | Cary, IL 60013-1907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2016 |
Last Update Date | 11/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041376232 | RN LICENSE (01) | IL |
277100372 | FULL PRACTICE AUTHORITY STATE LICENSE (01) | |
337001336 | CONTROLLED SUBSTANCE LICENSE (01) | IL |