Individual
LACI WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2239 E COOK ST, SPRINGFIELD, IL 62703-1944
(217) 788-2300
(217) 788-2343
Mailing address
475 MURRAY HILL AVE, TOVEY, IL 62570-4477
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.015954
IL
Other
Enumeration date
05/03/2017
Last updated
03/17/2018
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