| NPI | 1053804740 |
|---|---|
| Former Legal Business Name | DERMATOLOGY AND MEDICAL CLINIC, LLC |
| Entity Type | Organization |
| Authorized Contact | TRACY DAWN ARNOLD Owner, Np C 618-918-2566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209009665) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2020-01-22 |