Individual
LAVADA RAINIER SIMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1003 E MCCORD ST, CENTRALIA, IL 62801-3345
(618) 436-6633
Mailing address
1003 E MCCORD ST, CENTRALIA, IL 62801-3345
(618) 436-6633
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209028436041414056
IL
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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