Organization
CENTRAL ILLINOIS FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CURTIS WAGNER II FNP (FAMILY NURSE PRACTITIONER)
(217) 213-5254
Entity
Organization
Contact information
Practice address
603 N LOGAN AVE, DANVILLE, IL 61832-4320
(217) 213-5254
(217) 213-5240
Mailing address
603 N LOGAN AVE, DANVILLE, IL 61832-4320
(217) 213-5254
(217) 213-5240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209003483041
IL
Other
Enumeration date
01/05/2011
Last updated
01/05/2011
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