Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209015669 | IL |
NPI | 1013453281 |
---|---|
Provider Name | Nicole Miroballi |
First Address | Chicago, IL 60622-2015 |
Second Address | Chicago, IL 60622-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2017 |
Last Update Date | 17/03/2018 |