Individual
RIVER ANDRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
819 BLOOMINGTON RD, CHAMPAIGN, IL 61820-2101
(217) 356-1558
Mailing address
2106 GEORGETOWN CIR, CHAMPAIGN, IL 61821-6422
(217) 649-6792
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.006815
IL
Other
Enumeration date
11/08/2018
Last updated
01/03/2020
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