Individual
KEITH SAMUEL BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
513 N MAIN ST, ANNA, IL 62906-1668
(618) 833-4471
Mailing address
20 LYNWOOD LN, ANNA, IL 62906-3265
(217) 898-3462
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209015848
IL
363LF0000X
Family Nurse Practitioner
Primary
277002840
IL
Other
Enumeration date
07/21/2017
Last updated
01/05/2024
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