| NPI | 1750756979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MISKELL Owner/Provider 815-431-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: IL 209009286) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2021-02-04 |