Individual
MRS. DESTINY GRACE PETROWICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1603 W KIMMEL ST, MARION, IL 62959-1008
(618) 993-2906
Mailing address
1603 W KIMMEL ST, MARION, IL 62959-1008
(618) 993-2906
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007902
IL
Other
Enumeration date
06/09/2020
Last updated
09/24/2022
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