Individual
JANESSA VANDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1118 HAMPSHIRE ST, QUINCY, IL 62301-3027
(217) 222-6550
Mailing address
1118 HAMPSHIRE ST, QUINCY, IL 62301-3027
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
055.0031291
VT
363A00000X
Physician Assistant
Primary
085008526
IL
363AS0400X
Surgical Physician Assistant
0550031291
VT
Other
Enumeration date
03/04/2016
Last updated
08/15/2021
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