Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 209014295 | IL |
NPI | 1033652243 |
---|---|
Provider Name | Mrs. Sonal Mukesh Patel |
First Address | Bloomington, IL 61704-2101 |
Second Address | Bloomington, IL 61704-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2016 |
Last Update Date | 21/11/2016 |