Individual
NICOLE M ISENHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
119 W MAIN ST, BELLEVILLE, IL 62220-1560
(618) 979-0661
Mailing address
1506 E MAIN ST, BELLEVILLE, IL 62221-5436
(618) 979-0661
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
03/13/2023
Last updated
03/13/2023
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