Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016005112 | IL |
NPI | 1033160437 |
---|---|
Provider Name | Suzanne S White |
First Address | Peoria, IL 61615-9213 |
Second Address | Pekin, IL 61554-6237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U98928 | (02) | IL |