Individual
MS. YVONNE M MCCALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1701 W. GARDEN STREET, PEORIA, IL 61605-3531
(309) 680-7600
(309) 680-7637
Mailing address
1701 W. GARDEN STREET, PEORIA, IL 61605-3531
(309) 680-7600
(309) 676-5506
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5160373-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-003423
STATE LICENSE
IL
01
—
1054008
NCCPA BOARD CERTIFICATION
UT
01
—
5160373-1206
STATE LICENSE
UT
01
—
5160373-8906
DOPL CONTROLLED SUBSTANCE
UT
01
—
PRA07224
MOLINA HEALTHCARE OF UT
UT
Enumeration date
12/09/2006
Last updated
01/16/2014
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