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Individual

MICHAEL RYAN MANDRELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
APRN

Contact information

Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2000
Mailing address
101 EAST ST, MORTON, IL 61550-1304
(309) 530-0690

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209015693
IL

Other

Enumeration date
11/21/2018
Last updated
11/21/2018
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