| NPI | 1558665596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CURTIS WAGNER Family Nurse Practitioner 217-213-5254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209003483041) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |