Individual
LISA JO SUWANAWONGSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
100 DR WARREN TUTTLE DR, HARRISBURG, IL 62946-2718
(618) 253-7671
(618) 253-0474
Mailing address
PO BOX 428, HARRISBURG, IL 62946-0428
(618) 253-7671
(618) 253-0474
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016422
IL
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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