| NPI | 1063446938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA DIANE HANLEY Hr Manager 217-849-3211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209005982) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-01-04 |