Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 227.011956 | IL |
NPI | 1679952956 |
---|---|
Provider Name | Nicole Lynn Duvall |
First Address | Freeport, IL 61032-6838 |
Second Address | Freeport, IL 61032-6838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 07/05/2020 |