Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | IL |
NPI | 1194936500 |
---|---|
Provider Name | Olga Amusina |
First Address | Evanston, IL 60201-1718 |
Second Address | Highland Park, IL 60035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 08/07/2007 |