Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209009357 | IL |
NPI | 1306117213 |
---|---|
Provider Name | Ms. Regina Wan |
First Address | Chicago, IL 60617-3909 |
Second Address | Chicago, IL 60617-3909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 15/03/2017 |