| NPI | 1790496099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY ANN RUSHING Nurse Practitioner 217-904-3035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2023-03-23 |