Individual
KYLA RUTH FARQUHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
596 KNOLLS ST W, DEKALB, IL 60115-8992
(312) 564-2300
Mailing address
596 KNOLLS ST W, DEKALB, IL 60115-8992
(630) 401-2364
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F62650090697
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/01/2022
Last updated
06/01/2022
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