Ms. Mitzie Ralph Fairfield
Nurse Practitioner - Women's Health
302 E. Stoughton
Champaign
, Illinois 61820
Ms. Mitzie Ralph Fairfield
Nurse Practitioner - Women's Health
302 E. Stoughton
Champaign
, Illinois 61820
(217) 897-1096
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About
Features
Specialties
- Nurse Practitioner - Women's Health
Languages spoken
- English
Location
First Address
- Ms. Mitzie Ralph Fairfield
- 615 County Rd 3400 North
- Foosland, IL
- Zip : 61845
- Phone : (217) 897-1096
Second Address
- Ms. Mitzie Ralph Fairfield
- 302 E. Stoughton
- Champaign, IL
- Zip : 61820
- Phone : (217) 359-8022
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LW0102X | Nurse Practitioner - Women's Health | 209-000689 | IL |
National Provider Identifier
| NPI | 1063580058 |
|---|---|
| Provider Name | Ms. Mitzie Ralph Fairfield |
| First Address | Foosland, IL 61845 |
| Second Address | Champaign, IL 61820 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/11/2006 |
| Last Update Date | 24/10/2008 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.