Individual
MR. JONATHAN LEE MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
11531 SUNDERLAND RD # A, MARION, IL 62959-8274
(618) 534-3624
Mailing address
11531 SUNDERLAND RD, MARION, IL 62959-8274
(618) 964-5139
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.118516
IL
Other
Enumeration date
07/28/2022
Last updated
08/04/2022
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