Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209014617 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 277000587 | IL |
NPI | 1003361619 |
---|---|
Provider Name | Mrs. Tamyra Michelle Janicki |
First Address | Downers Grove, IL 60515-5602 |
Second Address | Downers Grove, IL 60515-5602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2016 |
Last Update Date | 18/01/2022 |