Individual
BETH MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 W MADISON ST, MILLSTADT, IL 62260-1428
(618) 980-3819
Mailing address
520 W MADISON ST, MILLSTADT, IL 62260-1428
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2010013255
MO
163W00000X
Registered Nurse
206901
SC
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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