| NPI | 1689865818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH HEGG Assistant Secretary 217-709-2469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2019-03-20 |