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General NPI Number Information
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NPI Number | 1740596394
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Entity Type | Organization
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Legal Business Name | WNUCARE
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 301 EAST BROADWAY
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City | ALTON
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State | IL
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Zip | 62002-5280
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Country | US
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Telephone | 618-470-4236
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Fax | 618-433-9090
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Provider Business Mailing Address
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Address Line | 1020 APT A ALTON POINT CIRCLE DRIVE
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City | ALTON
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State | IL
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Zip | 62002-5280
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Country | US
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Telephone | 618-410-4236
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Fax | 161-833-9090
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Authorized Official
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Title or Position | DIETETIC TECHNITION REGISTERED NUTR
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Name | MS. JULIA LYNN PHILLIPS
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Credential | DTR
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Telephone | 618-410-4236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 302R00000X
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License Number State | IL
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