Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036-078589 | IL |
Y | 208600000X | Surgeon | 036-078589 | IL |
NPI | 1003829169 |
---|---|
Provider Name | Nancy E Whereatt |
First Address | Aurora, IL 60506-6222 |
Second Address | Aurora, IL 60506-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036078589 | (05) | IL |
04515143 | BCBS# (01) | IL |
F34617 | (02) |