| NPI | 1992993570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH HEGG Assistant Secretary 217-709-2469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2018-05-04 |