Board of Trustees of Southern Illinois University

NPI #1104230168 in East Saint Louis, Illinois

Provider Information

NPI Number: 1104230168
Entity Type: Organization
Organization Name: Board of Trustees of Southern Illinois University
Primary Specialty: Clinic/Center
Enumeration Date: Jun 18, 2014
Last Updated: Jan 8, 2025

Practice Location

Address: 601 JAMES R THOMPSON BLVD
Address 2: BUILDING D, SUITE 2015
City: East Saint Louis
State: Illinois
ZIP Code: 62201-1129
Phone: (618) 482-6959

Authorized Official

Name: DR. MYJAL GARNER, DNP, APRN, FNP-C
Title: DIRECTOR
Phone: (618) 482-6959

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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