Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | IL |
NPI | 1003908062 |
---|---|
Provider Name | Mrs. Nanci Janine Edgcomb |
First Address | Gurnee, IL 60031 |
Second Address | Gurnee, IL 60031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4921352 | BLUE CROSS BLUE SHIELD (01) | IL |