Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 209-004053 | IL |
NPI | 1053599423 |
---|---|
Provider Name | Ms. Greta Obereiner |
First Address | Champaign, IL 61820-3909 |
Second Address | Champaign, IL 61822-6217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2008 |
Last Update Date | 24/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00479932 | RAILROAD MEDICARE (01) | IL |