Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | IL |
NPI | 1518926047 |
---|---|
Provider Name | Ms. Donna Lynn Hanetho |
First Address | Schaumburg, IL 60193-1833 |
Second Address | Mt Prospect, IL 60056-6089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 08/07/2007 |