Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036-059721 | IL |
NPI | 1043361728 |
---|---|
Provider Name | Nancy C Lichon |
First Address | Chicago, IL 60674-0001 |
Second Address | Lombard, IL 60148-5371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E24266 | (02) | IL |