DIETRA LEIGH ANGELLY

MARION, IL
NPI1902371313
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: IL  209018044)
Additional Taxonomies363LF0000X Nurse Practitioner, Family
(Licence: IL  209018044)
Enumeration Date2018-10-11
Last Update Date2024-04-08
Business Address
DIETRA LEIGH ANGELLY FNP-C
3411 PROFESSIONAL PARK DR
MARION, IL 62959-6394
Phone number: 618-969-8630
Mailing Address
DIETRA LEIGH ANGELLY FNP-C
408 LINCOLN DR STE B
HERRIN, IL 62948-3790
Phone number: 618-351-4980