Mayberry, Joanne
Mayberry, Joanne is an individual health care provider with primary practice located at 125 E Plummer Blvd , Chatham IL 62629-8134. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Mayberry, Joanne can be contacted via phone (172) 483-3333.Contact Information
Primary practice address
125 E Plummer Blvd
Chatham IL 62629-8134
Phone: (172) 483-3333
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 125075108 | Illinois |
Profile Details
| NPI number | 1366976482 |
|---|---|
| LBN Legal business name | Mayberry, Joanne |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2017 |
| Last updated | Jul 18th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366976482 | NPPES |
| Illinois | Other | 125078108 | RESIDENT LICENSE |
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