Individual
MARTHA CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1130 E WALNUT ST STE 100, CARBONDALE, IL 62901-5007
(618) 351-1031
Mailing address
601 CALLIE CT, HERRIN, IL 62948-3055
(815) 573-1303
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043081887
IL
Other
Enumeration date
03/17/2023
Last updated
03/17/2023
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