Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209-005563 | IL |
NPI | 1417168022 |
---|---|
Provider Name | Poome Chamnankit |
First Address | Evanston, IL 60201-1700 |
Second Address | Evanston, IL 60201-1718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 04/06/2020 |