Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036-088059 | IL |
NPI | 1124138318 |
---|---|
Provider Name | Patricia I. Ittmann |
First Address | Rockford, IL 61103-3655 |
Second Address | Rockford, IL 61103-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036088059 | (05) | IL |
H84970 | (02) | IL |