Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 209.015934 | IL |
NPI | 1013443993 |
---|---|
Provider Name | Mrs. Theresa Donley |
First Address | Minooka, IL 60447-8431 |
Second Address | Joliet, IL 60435-5942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |