| NPI | 1386950764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH DIANNE CARLSON Owner 217-741-4304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209006847) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-08-24 |