Individual
MRS. MAKALA LYNN RALPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1507 ROSER DR, CARMI, IL 62821-2229
(618) 384-9969
Mailing address
727 MARGUERITE ST, CARMI, IL 62821-2329
(618) 383-5943
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111086138
—
IL
Enumeration date
07/19/2021
Last updated
07/19/2021
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