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Organization
MULLIN MEMORIAL RURAL HEALTH SERVICES, LLC
Active
Organization
MULLIN MEMORIAL RURAL HEALTH SERVICES, LLC
Active
Other names
MULLIN MEMORIAL RURAL HEALTH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERRY L DESALLE FNP (OWNER)
(815) 445-2213
Entity
Organization
Contact information
Practice address
320 SOUTH SECOND STREET, MANLIUS, IL 61338
(815) 445-2273
(815) 445-2213
Mailing address
320 SOUTH SECOND STREET, P.O. BOX 375, MANLIUS, IL 61338
(815) 445-2273
(815) 445-2213
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176406892001
—
IL
Enumeration date
05/23/2006
Last updated
08/22/2020
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