Individual
BOMINA OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2501
(217) 383-3311
Mailing address
611 W PARK, FAPC, URBANA, IL 61802
(217) 902-6954
(217) 902-7711
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209030394
IL
Other
Enumeration date
09/03/2024
Last updated
12/27/2024
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