Individual
MRS. MARY O WUNDERLICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
325 SPRING STREET, RED BUD, IL 62278
(618) 282-3831
(618) 282-5476
Mailing address
325 SPRING STREET, RED BUD, IL 62278
(618) 282-3831
(618) 282-5476
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085000332
IL
363AM0700X
Medical Physician Assistant
085-000332
IL
Other
Enumeration date
12/06/2010
Last updated
01/25/2023
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