Individual
MCKINLEY MARSEILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, CRNA
Contact information
Practice address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 842-2828
Mailing address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 842-2828
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
28268295A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
209025510
IL
367500000X
Certified Registered Nurse Anesthetist
28268295A
IN
Other
Enumeration date
09/20/2021
Last updated
02/05/2026
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