Individual
GRETCHEN WAYNE FAWCETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
408 S MAIN ST, LEWISTOWN, IL 61542-1563
(309) 547-9700
(309) 649-6880
Mailing address
180 S MAIN ST, CANTON, IL 61520-2608
(309) 647-0201
(309) 649-5101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
85001592
IL
Other
Enumeration date
10/03/2006
Last updated
04/06/2021
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