Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | F07151017 | IL |
NPI | 1619352036 |
---|---|
Provider Name | Rhonda Scott-Diltz |
First Address | South Elgin, IL 60177-2723 |
Second Address | Elgin, IL 60123-2300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2015 |
Last Update Date | 27/07/2015 |