Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 209019958 | IL |
NPI | 1093340275 |
---|---|
Provider Name | Nicole Price |
First Address | Chicago, IL 60626-2664 |
Second Address | Chicago, IL 60613-4098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2020 |
Last Update Date | 07/03/2020 |