Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 227003078 | IL |
NPI | 1649670738 |
---|---|
Provider Name | Mrs. Sonja Marie Frei |
First Address | Minonk, IL 61760-1429 |
Second Address | Minonk, IL 61760-1429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 26/08/2014 |