Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209061434 | IL |
NPI | 1033627062 |
---|---|
Provider Name | Roma Patel |
First Address | Elmhurst, IL 60126-4535 |
Second Address | Aurora, IL 60506-3814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 11/01/2018 |