15 Park Place LLC

NPI #1447870274 in Swansea, Illinois

Provider Information

NPI Number: 1447870274
Entity Type: Organization
Organization Name: 15 Park Place LLC
Primary Specialty: Internal Medicine
Enumeration Date: Apr 22, 2020
Last Updated: Jul 8, 2020

Practice Location

Address: 15 PARK PL STE 1
City: Swansea
State: Illinois
ZIP Code: 62226-2918
Phone: (618) 580-1359

Authorized Official

Name: CLARA AMPADU, FNPC
Title: CEO
Phone: (618) 580-1359

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner - Primary Care — Primary Care	363LP2300X
Internal Medicine	207R00000X	Primary

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