Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 041372979 | IL |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 209013455 | IL |
NPI | 1023462785 |
---|---|
Provider Name | Tocarra Dantzler |
First Address | Chicago, IL 60612-2685 |
Second Address | Chicago, IL 60612-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 19/04/2016 |