Individual
MRS. CANDICE N GREMLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 W COURT ST, KANKAKEE, IL 60901-3661
(815) 937-2100
Mailing address
500 W COURT ST, KANKAKEE, IL 60901-3661
(815) 937-2100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002749
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4622394
BLUE CROSS
—
Enumeration date
09/16/2006
Last updated
04/07/2009
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