Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209015336 | IL |
NPI | 1003347592 |
---|---|
Provider Name | Tricia Muir |
First Address | Chicago, IL 60613-3077 |
Second Address | Chicago, IL 60613-3077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2017 |
Last Update Date | 25/03/2017 |