| NPI | 1609657980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH RENEE TUCKER Co Owner 309-840-3008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2023-10-28 |