| NPI | 1063646040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J. TRAVIS DOWELL Vice President Hcna And Operations 217-788-3342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2009-05-06 |