| NPI | 1316124159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA KAY FULLER Medical Assistant 309-762-5515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209006754) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2008-01-23 |