Individual
JESSICA RAYANN DISMANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
315 N ALLEN ST APT 2, CROSSVILLE, IL 62827-2284
(618) 380-1452
Mailing address
PO BOX 205, CROSSVILLE, IL 62827-0205
(618) 380-1452
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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