Individual
MS. MITZIE RALPH FAIRFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
302 E. STOUGHTON, CHAMPAIGN, IL 61820
(217) 359-8022
Mailing address
615 COUNTY RD 3400 NORTH, FOOSLAND, IL 61845
(217) 897-1096
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
209-000689
IL
Other
Enumeration date
11/30/2006
Last updated
10/24/2008
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