Individual
MRS. BREANNE NICOLE MEKELBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
317 TEXAS AVE, CARTERVILLE, IL 62918-1430
(618) 203-3954
Mailing address
317 TEXAS AVE, CARTERVILLE, IL 62918-1430
(618) 203-3954
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043118022
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164W00000X
—
IL
Enumeration date
02/15/2017
Last updated
02/15/2017
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