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Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Other names
Southern Illinois University Edwardsville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYJAL GARNER DNP, APRN, FNP-C (DIRECTOR)
(618) 482-6959
Entity
Organization
Contact information
Practice address
601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015, EAST SAINT LOUIS, IL 62201-1129
(618) 482-6959
(618) 482-8311
Mailing address
601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015, EAST SAINT LOUIS, IL 62201-1129
(618) 482-6959
(618) 482-8311
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/18/2014
Last updated
07/15/2026
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