| NPI | 1962937300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE L CARSON Billing Sup 618-632-8611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 042617962) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2017-04-24 |