Individual
CANDACE DONYUSHA CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4965 STONE FALLS CTR STE 7, O FALLON, IL 62269-7803
(618) 726-2500
Mailing address
3 PROFESSIONAL DR, STE B, ALTON, IL 62002-5067
(618) 465-7177
(618) 465-7176
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004583
IL
Other
Enumeration date
01/14/2008
Last updated
08/02/2018
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