Individual
WANDA SANTOS CIULLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
509 S MAIN ST, PARIS, IL 61944-2325
(217) 465-8053
Mailing address
10027 INDIAN BOUNDARY ST, PARIS, IL 61944-8253
(217) 465-5442
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
085000243
NY
208D00000X
General Practice Physician
085000243
NY
363A00000X
Physician Assistant
085000243
NY
363AM0700X
Medical Physician Assistant
085000243
IL
363AM0700X
Medical Physician Assistant
Primary
085000243
NY
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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