Individual
MRS. MARILYN STOMBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4107 S WATER TOWER PL, MOUNT VERNON, IL 62864-6293
(618) 244-0031
Mailing address
14739 N COUNTY FARM LN, MOUNT VERNON, IL 62864-9895
(618) 241-9619
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
IL
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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