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NPI Code Detail

MEDICARE: MRS. JUDITH A WAKELAND PAC

MEDICARE: MRS. JUDITH A WAKELAND PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse041127252IL
2363A00000XPhysician Assistant085001026IL

General Provider Information

NPI Number : 1831160779
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUDITH A WAKELAND PAC
Provider Business Mailing Address
First Line : 1000 W HARLEM AVE
Second Line :
City : MONMOUTH
State : IL
Zip : 61462-1099
Country : US
Telephone Number : 309-734-3141
Fax Number : 309-734-3029
Provider Business Practice Location Address
First Line : 1000 W HARLEM AVE
Second Line :
City : MONMOUTH
State : IL
Zip : 61462-1099
Country : US
Telephone Number : 309-734-3141
Fax Number : 309-734-3029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 07/29/2014

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Directions to “ MRS. JUDITH A WAKELAND PAC” Practice Location

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