Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 209-018500 | IL |
NPI | 1164993853 |
---|---|
Provider Name | Mrs. Margaret Petry |
First Address | Mount Vernon, IL 62864-5950 |
Second Address | Shiloh, IL 62221-4465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 14/09/2021 |