Individual
TERRI FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
323 W MULBERRY ST, WATSEKA, IL 60970-1568
(815) 432-5241
Mailing address
PO BOX 322, WATSEKA, IL 60970-0322
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043050150
IL
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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