Individual
MRS. SHIRLEY MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
625 E US HIGHWAY 36, TUSCOLA, IL 61953-7505
(217) 253-1235
(217) 253-4238
Mailing address
5414 WOODARD SCHOOL ROAD, SALEM, IL 62881-4548
(618) 548-0405
(217) 253-4238
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002240
IL
Other
Enumeration date
04/20/2007
Last updated
02/11/2009
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