Individual
EVANS M MUTUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
720 N BOND ST, SPRINGFIELD, IL 62702-4952
(217) 545-8000
(217) 545-6544
Mailing address
PO BOX 19662, SPRINGFIELD, IL 62794-9662
(217) 545-8000
(217) 545-6544
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209-017928
IL
Other
Enumeration date
09/25/2018
Last updated
12/08/2020
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