Individual
MRS. MARY J WALLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.N
Contact information
Practice address
300 N MAPLE ST, EFFINGHAM, IL 62401-2003
(217) 342-4151
(217) 342-4190
Mailing address
P.O. BOX 1268, 300 NORTH MAPLE STREET, EFFINGHAM, IL 62401
(217) 342-4151
(217) 342-4190
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043051122
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043051122
LICENSE
IL
Enumeration date
12/23/2009
Last updated
12/23/2009
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