Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036138995 | IL |
Y | 2080P0210X | Pediatric Nephrologist | 036-138995 | IL |
NPI | 1952663338 |
---|---|
Provider Name | Nazia Kulsum-Mecci |
First Address | Springfield, IL 62701-1041 |
Second Address | Springfield, IL 62701-1041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 21/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036138995 | (05) | IL |