Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 209.015147 | IL |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209.015147 | IL |
NPI | 1316498934 |
---|---|
Provider Name | Mrs. Melanie Dacumos Yoingco |
First Address | Gurnee, IL 60031-1095 |
Second Address | Highland Park, IL 60035-2433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2016 |
Last Update Date | 26/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316498934 | (05) | IL |