Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 227009959 | IL |
NPI | 1891175725 |
---|---|
Provider Name | Quaneta Gates |
First Address | Homewood, IL 60430 |
Second Address | Homewood, IL 60430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 05/06/2015 |