Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 209019161 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209019161 | IL |
NPI | 1275096810 |
---|---|
Provider Name | Mrs. Rose Mcclure Dwyer |
First Address | Chicago, IL 60613-3677 |
Second Address | Chicago, IL 60637-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 10/04/2019 |