Individual
IVA WASHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
211 FULTON ST, STE 207, PEORIA, IL 61602-1347
(309) 671-8700
Mailing address
211 FULTON ST, SUITE 207, PEORIA, IL 61602-1347
(309) 671-8700
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043052637
IL
Other
Enumeration date
01/18/2017
Last updated
01/18/2017
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