Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | IL |
NPI | 1043249824 |
---|---|
Provider Name | Ms. Ann Marie Simonelli |
First Address | Chicago, IL 60614-6007 |
Second Address | Chicago, IL 60614-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/07/2007 |