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
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366976482 NPPES
Illinois Other 125078108 RESIDENT LICENSE

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