Individual
EMILY BROOKE NULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6665 IL-146 E, VIENNA, ID 62995-9998
(618) 658-8331
Mailing address
6665 IL-146 E, VIENNA, IL 62995-9998
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.009966
IL
Other
Enumeration date
08/17/2023
Last updated
05/13/2025
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