| NPI | 1124316286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH CARLSON Owner 217-391-6301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: IL APN209006847) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2011-07-11 |