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 |