Organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Active
Other names
Southern Illinois University Edwardsville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYJAL GARNER DNP, APRN, FNP-C (DIRECTOR)
(618) 482-6959
Entity
Organization
Contact information
Practice address
601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015, EAST SAINT LOUIS, IL 62201-1129
(618) 482-6959
(618) 482-8311
Mailing address
601 JAMES R THOMPSON BLVD, BUILDING D, SUITE 2015, EAST SAINT LOUIS, IL 62201-1129
(618) 482-6959
(618) 482-8311
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/18/2014
Last updated
06/07/2026
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