Organization
CHARLESTON PRIMARY CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANELLE JACKSON MSN, APN, NP-C (OWNER)
(217) 276-6421
Entity
Organization
Contact information
Practice address
506 W LINCOLN AVE, SUITE 200, CHARLESTON, IL 61920-2453
(217) 348-8730
(217) 345-7146
Mailing address
506 W LINCOLN AVE, SUITE 200, CHARLESTON, IL 61920-2453
(217) 348-8730
(217) 345-7146
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/07/2014
Last updated
01/07/2014
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