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Search › Illinois › 183500000X

Ethan Vandersand

NPI 1316297088 · on the registry since 2012

Practice

Address
400a W Carpenter St
Jerseyville, IL 62052
Phone
(618) 498-6461
Organisation at this address
Gelsthorpes Inc
Mallex Corporation
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy
183500000X
183500000X
Licence states on file
IL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2012-09-10

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois