Individual
LYDIA VANNATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-5000
Mailing address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
078202
IA
Other
Enumeration date
06/16/2015
Last updated
01/24/2023
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