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1063580058
MITZIE RALPH FAIRFIELD
CHAMPAIGN, IL
NPI
1063580058
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LW0102X Nurse Practitioner, Women's Health
(Licence: IL 209-000689)
Enumeration Date
2006-11-30
Last Update Date
2008-10-24
Business Address
Ms. MITZIE RALPH FAIRFIELD NP
302 E. STOUGHTON
CHAMPAIGN, IL 61820
Phone number: 217-359-8022
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Mailing Address
Ms. MITZIE RALPH FAIRFIELD NP
615 COUNTY RD 3400 NORTH
FOOSLAND, IL 61845
Phone number: 217-897-1096
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