Individual
MARLON PEMBERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(309) 454-1100
(309) 454-1107
Mailing address
1604 VISA DR STE 1, NORMAL, IL 61761-2195
(309) 454-1100
(309) 454-1107
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
246ZE0600X
NY
Other
Enumeration date
01/11/2017
Last updated
01/11/2017
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