| NPI | 1851992713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODNEY WILLEY Owner 309-303-0426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223X2210X Dentist, Orofacial Pain | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |