| NPI | 1922476241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL S JESENICK Family Nurse Practitioner 618-622-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209006003) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2016-05-03 |