Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 209020166 | IL |
NPI | 1174166581 |
---|---|
Provider Name | Sarah Elizabeth Colon |
First Address | Chicago, IL 60647-9692 |
Second Address | Hines, IL 60141-3030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2019 |
Last Update Date | 18/10/2019 |