Individual
SARA LOUISE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4600 3RD ST, MOLINE, IL 61265-6106
(309) 779-5000
Mailing address
4600 3RD ST, MOLINE, IL 61265-6106
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
107727
IA
Other
Enumeration date
07/05/2018
Last updated
07/05/2018
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