Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 209017678 | IL |
NPI | 1023508769 |
---|---|
Provider Name | Stephanie Birmingham |
First Address | Rockford, IL 61103-3655 |
Second Address | Rockford, IL 61103-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 17/05/2018 |