Individual
KAREN DIANE HUMMEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1441 W BROADWAY, CENTRALIA, IL 62801-5613
(618) 532-9050
Mailing address
PO BOX 955860, SAINT LOUIS, MO 63195-5309
(636) 498-5944
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002330
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208959
MEDICARE GRP NUMBER
IL
01
—
DD8320
GROUP MED RR NUMBER
IL
01
—
P00619153
MEDICARE RR NUMBER
IL
Enumeration date
05/15/2006
Last updated
11/23/2020
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