Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 209.023833 | IL |
NPI | 1114599248 |
---|---|
Provider Name | Zoe A. Due |
First Address | Springfield, IL 62794-9248 |
Second Address | Peoria, IL 61606-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2021 |
Last Update Date | 19/08/2021 |