Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209013138 | IL |
NPI | 1003273434 |
---|---|
Provider Name | Mrs. Sonia Mahmood |
First Address | South Elgin, IL 60177-3315 |
Second Address | South Elgin, IL 60177-3315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2016 |
Last Update Date | 01/11/2021 |