| NPI | 1104461870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DINA G SWANSON Nurse Practitioner 217-552-6687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-11-16 |
| Last Update Date | 2025-12-31 |