Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1164195699 |
---|---|
Provider Name | Mrs. Jennette Marie Hollister |
First Address | Rockford, IL 61102-2112 |
Second Address | Rockford, IL 61102-2112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2021 |
Last Update Date | 29/07/2021 |