Individual
EVALYNNE D BASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 E TRIPP AVE, PEORIA, IL 61603-1221
(309) 472-4643
Mailing address
601 E TRIPP AVE, PEORIA, IL 61603-1221
(309) 472-4643
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.023675
IL
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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