Deaconess Illinois Specialty Clinic, Inc.
NPI #1497462964 in Mount Vernon, Illinois
Provider Information
- NPI Number
- 1497462964
- Entity Type
- Organization
- Organization Name
- Deaconess Illinois Specialty Clinic, Inc.
- Primary Specialty
- Nurse Practitioner
- Enumeration Date
- Nov 3, 2022
- Last Updated
- Jan 26, 2023
Practice Location
- Address
- 3111 BROADWAY ST
- City
- Mount Vernon
- State
- Illinois
- ZIP Code
- 62864-2338
- Phone
- (618) 241-0300
Authorized Official
- Name
- KYLE DILLMAN
- Title
- SECRETARY TREASURER
- Phone
- (812) 450-7399
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine - Sports Medicine — Sports Medicine |
| Nurse Practitioner |
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