Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209022933 | IL |
NPI | 1235712431 |
---|---|
Provider Name | Rosa Brito |
First Address | Chicago, IL 60617-1127 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2021 |
Last Update Date | 04/05/2021 |