Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 209-002307 | IL |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209002307 | IL |
NPI | 1053383471 |
---|---|
Provider Name | Ms. Barbara J Nall |
First Address | Peoria, IL 61614-5098 |
Second Address | Peoria, IL 61614-5098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 03/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041-180296 | RN LICENSE (01) | IL |
209-002307 | APN LICENSE (01) | IL |
NAL1-0428-3835 | CERT OF WHC NP (01) | IL |