Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 209018979 | IL |
NPI | 1043778772 |
---|---|
Provider Name | Rhonda J Gale |
First Address | Rockford, IL 61114-2300 |
Second Address | Rockford, IL 61114-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2019 |
Last Update Date | 12/03/2019 |