Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209023849 | IL |
NPI | 1003584590 |
---|---|
Provider Name | Roxanne Mclaughlin |
First Address | Peoria, IL 61615-7822 |
Second Address | Peoria, IL 61615-7822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2021 |
Last Update Date | 02/12/2021 |