| NPI | 1659632602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY ASKARI Vice President 618-993-6641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: IL 209.005527) |
| Additional Taxonomies | 133VN1006X Dietitian, Registered Nutrition, Metabolic (Licence: IL 164.003714) |
| 363AM0700X Physician Assistant Medical (Licence: IL 85.003452) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: IL 209.002243) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2014-05-20 |