Registry details
Type
Organization
Primary specialty
Nurse Practitioner, Family
Enumerated
Apr 13, 2026
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 1175 | O Fallon, IL 62269-8175 | 618-444-7231 |
| LOCATION | 14335 JAMESTOWN RD | Breese, IL 62230-3681 | 618-444-7231 |
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