Provider Information for 1326540121
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WENDY SUEY
Sex: Female
NPI: 1326540121
Last Updated: 2018-03-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1326540121 | ||||||||
| Enumeration Date | 2018-03-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 904 E. MARTIN LUTHER KING DRIVE CENTRALIA, IL 62801-3058 United States Phone: 618-533-1391 | Fax:618-533-0012 | ||||||||
| Primary Practice Address | 904 E. MARTIN LUTHER KING DRIVE CENTRALIA, IL 62801-3058 United States Phone: 618-533-1391 | Fax:618-533-0012 | ||||||||
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