Individual
CALEB PENNOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4474 OLD ROUTE 13, CARTERVILLE, IL 62918-3300
(618) 889-7076
Mailing address
4474 OLD ROUTE 13, CARTERVILLE, IL 62918-3300
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.122929
IL
Other
Enumeration date
09/02/2016
Last updated
09/02/2016
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