| NPI | 1124305636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN M. CIRONE Regional Mgr Reimb/Rev Recognition 309-672-4813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LS0200X Nurse Practitioner, School |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2020-02-14 |