Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 209010822 | IL |
NPI | 1043641509 |
---|---|
Provider Name | Mrs. Kimberly Yormark |
First Address | Chicago, IL 60611-2051 |
Second Address | Chicago, IL 60612-4795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2013 |
Last Update Date | 10/12/2013 |