Individual
MRS. TESSA DRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
698 N 33RD ST, DECATUR, IL 62521-1606
(309) 264-6898
Mailing address
698 N 33RD ST, DECATUR, IL 62521-1606
(309) 264-6898
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D620-8039-8956
IL
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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