Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209007963 | IL |
NPI | 1063736718 |
---|---|
Provider Name | Ms. Mary Theresa O'sullivan |
First Address | Hines, IL 60141-3030 |
Second Address | Hines, IL 60141-3030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2010 |
Last Update Date | 23/02/2015 |