Individual
MRS. GAYNELL SUE LADISLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
104 N GARFIELD ST, OBLONG, IL 62449-1426
(618) 592-3119
(618) 592-3875
Mailing address
104 N GARFIELD ST, OBLONG, IL 62449-1426
(618) 592-3119
(618) 592-3875
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209003339
IL
Other
Enumeration date
12/01/2005
Last updated
01/10/2012
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