Individual
LAUQUYTA NARVITA WILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
320 E CENTRAL AVE, DECATUR, IL 62521
(217) 877-9117
Mailing address
10852 S AVENUE E, CHICAGO, IL 60617-6748
(312) 966-9482
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-005620
IL
Other
Enumeration date
10/09/2015
Last updated
10/28/2021
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