Individual
WAYLAND J MUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-1200
Mailing address
1025 MAINE ST, QUINCY, IL 62301-4038
(217) 222-6550
(217) 277-2253
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
041326848
IL
363L00000X
Nurse Practitioner
Primary
209017279
IL
Other
Enumeration date
09/29/2017
Last updated
03/22/2018
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