Individual
FREDERICA JO NANNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4241 HWY 14 W, CHRISTOPHER, IL 62822-0155
(618) 724-2401
(618) 724-4628
Mailing address
PO BOX 155, CHRISTOPHER, IL 62822-0155
(618) 724-2401
(618) 724-4628
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036110047
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110047
—
IL
05
—
370966854004
—
IL
01
—
CF3444
MEDICARE RAILROAD GROUP
IL
Enumeration date
06/01/2006
Last updated
11/22/2011
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