| NPI | 1326229774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI LYNN BLAGG Apn Owner 217-235-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209005102) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2008-01-23 |