Individual
ERA LOUISE MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
11522 WHITE PINE AVE, MARION, IL 62959-8379
(618) 889-4834
Mailing address
11522 WHITE PINE AVE, MARION, IL 62959-8379
(618) 889-4834
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209019019
IL
Other
Enumeration date
03/31/2019
Last updated
03/31/2019
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