| NPI | 1679270763 |
|---|---|
| Doing Business As | DEACONESS ILLINOIS SPECIALTY CLINIC OCCUPATIONAL HEALTH BROADWAY |
| Entity Type | Organization |
| Authorized Contact | KYLE DILLMAN Secretary 812-450-7399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-02-09 |