Provider Demographics
NPI:1306007166
Name:ATKINSON, MIRI L (CST/CFA, RSA)
Entity Type:Individual
Prefix:MRS
First Name:MIRI
Middle Name:L
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:CST/CFA, RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 SPAULDING RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1221
Mailing Address - Country:US
Mailing Address - Phone:630-347-1312
Mailing Address - Fax:
Practice Address - Street 1:1581 SPAULDING RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-1221
Practice Address - Country:US
Practice Address - Phone:630-347-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000132246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant