Individual
DR. ETINOSA ANN IDEMUDIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2501
(217) 383-4229
Mailing address
5209 FOGGIA AVE, LAS VEGAS, NV 89130-7059
(862) 262-6012
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
125.086201
IL
Other
Enumeration date
06/04/2025
Last updated
06/04/2025
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