Mullin Memorial Rural Health Services, LLC
Organization Active NPI Family Nurse Practitioner · Manlius, IL
NPI 1851346316 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1851346316
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- MULLIN MEMORIAL RURAL HEALTH SERVICES, LLC
- Practice address
- 320 South Second Street
Manlius, IL 61338 - Phone
- (815) 445-2273
- Fax
- (815) 445-2213
- NPI assigned
- May 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sherry L Desalle, FNP
- Title
- Owner
- Phone
- (815) 445-2213
Corporate family (same tax ID) 1
Practitioners 2
-
Gregg E Davis, MD
-
Sherry L Desalle, FNP
National Provider Directory
- Tax ID family
- Mullin Memorial Health Services LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | IL | Yes |
Addresses
Primary practice location
320 South Second Street
Manlius, IL 61338
Mailing address
320 South Second Street
P.O. Box 375
Manlius, IL 61338
Phone (815) 445-2273
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 176406892001 | Medicaid | IL |
Other names
- MULLIN MEMORIAL RURAL HEALTH CLINIC
Other providers in Manlius, IL
- Bureau Valley Unit 340
- Sherry L Desalle
- Manlius Fire Protection District Fire Department
- Mullin Memorial Health Services LLC
All providers in Manlius, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.