Individual
MRS. MARY ELLEN ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
222 N SANGAMON AVE, GIBSON CITY, IL 60936
(217) 748-8148
(217) 784-8160
Mailing address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-4251
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
209001628
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362658552001
—
IL
Enumeration date
07/28/2006
Last updated
02/27/2024
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