Individual
JAMIE LYN MABRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN/CNP
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
Mailing address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209006061
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00428389
MEDICARE RAILROAD
IL
Enumeration date
08/01/2006
Last updated
05/20/2008
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