Individual
JESSICA SLATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1112 S WEST ST, OLNEY, IL 62450-1321
(618) 395-2147
(618) 392-2625
Mailing address
PO BOX 501, OLNEY, IL 62450-0501
(618) 838-6168
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041355133
IL
Other
Enumeration date
09/30/2019
Last updated
09/30/2019
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