Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 036-068870 | IL |
NPI | 1942296504 |
---|---|
Provider Name | Nancy Young |
First Address | Chicago, IL 60680-0618 |
Second Address | Chicago, IL 60614-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 23/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036068870 | (05) | IL |
1627123 | BCBS PROVIDER ID (01) | IL |
D16238 | (02) | IL |