Individual
MARGIE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
619 E MASON ST, SUITE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
Mailing address
619 E MASON ST, SUITE 4P57, SPRINGFIELD, IL 62701-1034
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209008390
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00907053
RR MEDICARE
IL
Enumeration date
11/17/2010
Last updated
03/12/2013
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