Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP60270270 | WA |
NPI | 1013273374 |
---|---|
Provider Name | Mrs. Mary Patricia Ko |
First Address | Burr Ridge, IL 60527 |
Second Address | Chicago, IL 60618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 18/11/2016 |