Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 43780 | KY |
N | 208000000X | Pediatrician | MD39365 | TN |
NPI | 1003903147 |
---|---|
Provider Name | Teresa Crase |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40241-2851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 12/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I31661 | (02) |