Individual
SARAH WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4241 HIGHWAY 14 W, CHRISTOPHER, IL 62822-1037
(618) 724-2401
Mailing address
14410 ROUTE 37, JOHNSTON CITY, IL 62951-3166
(618) 983-6911
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043122045
IL
Other
Enumeration date
11/17/2016
Last updated
11/17/2016
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