Individual
MELISSA ANNE FOWLER-COELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 W JACKSON ST STE 100, CARBONDALE, IL 62901-1474
(618) 457-0404
Mailing address
305 W JACKSON ST STE 100, CARBONDALE, IL 62901-1474
(618) 457-0404
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019377
IL
Other
Enumeration date
07/23/2019
Last updated
10/03/2019
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